1072. Post-Treatment Control of HIV Infection in an Early Diagnosed Well-characterized Military Cohort of Chronically HIV-1 Infected Subjects
Session: Poster Abstract Session: HIV: Basic Science and Pathogenesis
Friday, October 9, 2015
Room: Poster Hall
Background: Post-treatment controllers (PTCs) are a rare group of HIV-infected individuals with transient (TC) or durable viral control (DC) off antiretroviral therapy (ART) after a period of treatment most commonly initiated during acute HIV infection. Given the durable viral control off ART, these patients are of particular interest for HIV functional cure research. We used data from the US Military Natural History Study (NHS) to assess the prevalence and demographics of PTCs.

Methods: We retrospectively identified patients who had had a set-point viral load (VL) >1000 copies/ml [cpm], achieved virologic suppression [<400 cpm] for ≥48 weeks after initiating ART, who subsequently discontinued ART for ≥ 6 months and had VL determinations available after discontinuation. Subjects with virologic suppression for ≥6 months but <2 years off of ART were considered TC, while DC were individuals with virologic suppression for ≥2 years off of ART. We examined baseline demographics and VL prior, during, and after ART was discontinued.

Results: 27 of the 4623 subjects examined met our screening criteria. 23 of the 27 subjects, who had a median set-point VL of 37061cpm [range: 2645, >75,000], became rapidly viremic within 6 months of ART cessation {median VL 26439 cpm [range: 581, 97387]}. Four subjects met criteria for PTC (2 DC), all 4 were African American, and 3 were male. All four PTCs initiated ART during chronic infection (range: 1.28-5.44 yrs after their estimated seroconversion), their median set-point VL was 21312 cpm [range: 1008, 46773], and VL six months after cessation of cART was <50cpm. The 2 TCs had suppression for 9 and 12 months. While 1 DC had suppression for 35 months, the other suppressed for 26 months before restarting ART (for pregnancy planning) without ever developing a viremia to >400 cpm while off of ART.

Conclusion: We identified 4 PTC in the NHS; the results of our study are consistent with the rarity of PTCs reported in the literature.  Of note, thus far most identified PTCs have initiated ART in the acute stage of infection, while our study reports the first cases of PTC after initiating ART in chronic infection. The identification of PTCs and further inquiry into their immunologic and genetic characteristics will prove important in the search for a functional cure for HIV.

Matthew Perkins, MD1, Robert Deiss, MD2,3,4, Tahaniyat Lalani, MD3,5,6, William P. Bradley, MS7,8,9, Brian Agan, MD, FIDSA6,10, Timothy Whitman, DO3,11, Thomas O'bryan, MD3,4,12, Tomas Ferguson, MD, FIDSA3,13, Jason Okulicz, MD, FIDSA3,12 and Anuradha Ganesan, MD, MPH6,11,14, (1)Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, MD, (2)Naval Medical Center San Diego, San Diego, CA, (3)Infectious Disease Clinical Research Program, USUHS, Rockville, MD, (4)Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, (5)Naval Medical Center Portsmouth, Portsmouth, VA, (6)Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, (7)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (8)Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, (9)San Antonio Military Medical Center, JBSA Fort Sam Houston, TX, (10)Infectious Disease Clinical Research Program, USUHS, Bethesda, MD, (11)Walter Reed National Military Medical Center, Bethesda, MD, (12)San Antonio Military Medical Center, Fort Sam Houston, TX, (13)Tripler Army Medical Center, Honolulu, HI, (14)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD

Disclosures:

M. Perkins, None

R. Deiss, None

T. Lalani, None

W. P. Bradley, None

B. Agan, None

T. Whitman, None

T. O'bryan, None

T. Ferguson, None

J. Okulicz, None

A. Ganesan, None

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