Imperial College London
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Professor Sarah Fidler BSc. MBBS. FRCP. PhD

Faculty of Medicine, Department of Infectious Disease

Professor of HIV and Communicable Diseases
 
 
 
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Contact

 

+44 (0)20 7594 6230s.fidler

 
 
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Location

 

clinical trial centre Winston Churchill wingMedical SchoolSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Chereau:2017:10.1371/journal.pone.0173893,
author = {Chereau, F and Madec, Y and Sabina, C and Obel, N and Ruiz-Mateos, E and Chrysos, G and Fidler, S and Lehmann, C and Zangerle, R and Wittkop, L and Reiss, P and Hamouda, O and Estrada, Perez V and Leal, M and Mocroft, A and Garcia, De Olalla P and Ammassari, A and Monforte, AD and Mussini, C and Segura, F and Castagna, A and Cavassini, M and Grabar, S and Morlat, P and De, Wit S and Lambotte, O and Meyer, L},
doi = {10.1371/journal.pone.0173893},
journal = {PLOS ONE},
title = {Impact of CD4 and CD8 dynamics and viral rebounds on loss of virological control in HIV controllers},
url = {http://dx.doi.org/10.1371/journal.pone.0173893},
volume = {12},
year = {2017}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Objective:HIV controllers (HICs) spontaneously maintain HIV viral replication at low level without antiretroviral therapy (ART), a small number of whom will eventually lose this ability to control HIV viremia. The objective was to identify factors associated with loss of virological control.Methods:HICs were identified in COHERE on the basis of ≥5 consecutive viral loads (VL) ≤500 copies/mL over ≥1 year whilst ART-naive, with the last VL ≤500 copies/mL measured ≥5 years after HIV diagnosis. Loss of virological control was defined as 2 consecutive VL >2000 copies/mL. Duration of HIV control was described using cumulative incidence method, considering loss of virological control, ART initiation and death during virological control as competing outcomes. Factors associated with loss of virological control were identified using Cox models. CD4 and CD8 dynamics were described using mixed-effect linear models.Results:We identified 1067 HICs; 86 lost virological control, 293 initiated ART, and 13 died during virological control. Six years after confirmation of HIC status, the probability of losing virological control, initiating ART and dying were 13%, 37%, and 2%. Current lower CD4/CD8 ratio and a history of transient viral rebounds were associated with an increased risk of losing virological control. CD4 declined and CD8 increased before loss of virological control, and before viral rebounds.Discussion:Expansion of CD8 and decline of CD4 during HIV control may result from repeated low-level viremia. Our findings suggest that in addition to superinfection, other mechanisms, such as low grade viral replication, can lead to loss of virological control in HICs.
AU  - Chereau,F
AU  - Madec,Y
AU  - Sabina,C
AU  - Obel,N
AU  - Ruiz-Mateos,E
AU  - Chrysos,G
AU  - Fidler,S
AU  - Lehmann,C
AU  - Zangerle,R
AU  - Wittkop,L
AU  - Reiss,P
AU  - Hamouda,O
AU  - Estrada,Perez V
AU  - Leal,M
AU  - Mocroft,A
AU  - Garcia,De Olalla P
AU  - Ammassari,A
AU  - Monforte,AD
AU  - Mussini,C
AU  - Segura,F
AU  - Castagna,A
AU  - Cavassini,M
AU  - Grabar,S
AU  - Morlat,P
AU  - De,Wit S
AU  - Lambotte,O
AU  - Meyer,L
DO  - 10.1371/journal.pone.0173893
PY  - 2017///
SN  - 1932-6203
TI  - Impact of CD4 and CD8 dynamics and viral rebounds on loss of virological control in HIV controllers
T2  - PLOS ONE
UR  - http://dx.doi.org/10.1371/journal.pone.0173893
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000399353500028&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - http://hdl.handle.net/10044/1/48096
VL  - 12
ER  -
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