953. HIV Reservoir Size and Decay in 114 Individuals with Suppressed Plasma Virus for at Least Seven Years: Correlation with Age and Not ARV Regimen
Session: Oral Abstract Session: HIV Clinical Management
Friday, October 28, 2016: 11:45 AM
Room: 275-277
Background:The HIV latent reservoir is the sum of the replication-competent proviral copies in an infected person and is directly correlated to the PBMC proviral copy number as determined by PCR amplification. In suppressed individuals, the reservoir size over time is determined by the size at baseline (when first suppressed) and the proliferative and decay rates of cells that comprise the reservoir.

Methods:In this study we examined 114 HIV-infected persons on suppressive ART for a minimum of 7 years who had donated serial PBMC specimens to the UW CFAR Specimen Repository. We determined the HIV proviral copy number per million PBMCs, corrected for CD4 count, in 477 specimens from these patients collected after a minimum of 7 years and up to 15.5 years of viral suppression. Generalized estimating equations (GEE) with an exchangeable working correlation structure and robust standard errors were used to estimate associations between reservoir size and time, age at entry, ARV regimen and risk factors for acquisition of HIV.

Results: We found that 1) the reservoir size as determined by amplification of gag and pol was similar in all but a few patients in which gag result approached zero, likely representing gag mutations that impaired amplification; 2) the inter-subject baseline reservoir size varied widely between 0.01 and 4.8 pol copies per mcg gDNA and per CD4 cell; 3) the reservoir size was lower for those at younger ages when suppression was achieved; 4) the reservoir size was not affected by the specific ARV regimen needed to achieve and maintain suppression; and 5) the reservoir size declined with time (half-life was estimated at 12 years, 95% confidence interval of 6.2-240 years).

Conclusion: This is the largest, longitudinal HIV reservoir study to date and confirms previous investigations demonstrating a slow decay rate and no differential effect by antiretroviral regimen, but suggests an association between age at viral suppression and reservoir size.

Jonathan Golob, MD / PhD1,2, Joshua Stern, MS3, Sarah Holte, PhD4, Mari Kitahata, MD, MPH5, Heidi Crane, MD, MPH1, Robert Coombs, MD / PhD6, Erin Goecker, BS6, Anne Woolfrey, MD7 and Robert Harrington, MD1, (1)Medicine: Aid, University of Washington, Seattle, WA, (2)Vaccine and Infectious Disease, Fred Hutchinson Cancer Research Center, Seattle, WA, (3)Global Health, University of Washington, Seattle, WA, (4)Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, (5)Center for AIDS Research, University of Washington, Seattle, WA, (6)Laboratory Medicine, University of Washington, Seattle, WA, (7)Medicine: Oncology, University of Washington, Seattle, WA

Disclosures:

J. Golob, None

J. Stern, None

S. Holte, None

M. Kitahata, None

H. Crane, None

R. Coombs, None

E. Goecker, None

A. Woolfrey, None

R. Harrington, None

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