Total cellular HIV-1 DNA decreases after switching to raltegravir-based regimens in patients with suppressed HIV-1 RNA

- HIV-1 RNA is often detected by ultrasensitive methods in patients on successful ART.
- HIV-1 DNA is detected in blood cells in virtually all patients on successful ART.
- Switch from NNRTI or PI to raltegravir-based ART can decrease cellular HIV-1 DNA.
- Residual HIV-1 RNA is not affected by switching from NNRTI or PI to RAL-based ART.
- Switching to a RAL-based regimen may help to reduce the size of the HIV reservoir.

BackgroundThe integrase inhibitor raltegravir has been used to intensify antiretroviral therapy in patients with undetectable plasma HIV-1RNA, resulting in variable perturbation of HIV-1 nucleic acids levels in peripheral blood.ObjectivesWe aimed at monitoring residual plasma HIV-1RNA and total cellular HIV-1DNA in virologically suppressed patients switching to raltegravir-based regimens.Study designFifty-eight subjects on protease inhibitor (PI) or nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens, with plasma HIV-1RNA levels <40 copies/ml for ≥6 months and CD4 counts >200 cells/μl for ≥12 months were enrolled. Thirty-four patients were from the treatment simplification RASTA randomized study switching standard therapy to a raltegravir-based regimen (RASTA group), while 24 continued a PI or NNRTI based-regimen (controls). Residual plasma HIV-1RNA (5-40 copies/mL) and HIV-1DNA were assessed at 0, 24 and 48 weeks.ResultsAt week 0 (W0), HIV-1DNA was detected in all patients while at W48 it was detectable in 82.4% of the RASTA group vs 100% of controls (p = 0.03). There was a significant decline of HIV-1DNA at W48 in the RASTA group (mean change from baseline −0.21 [95% CI −0.41; −0.01] log10 copies/106 CD4; p = 0.03) but not in controls. Ultrasensitive HIV-1RNA was detectable at baseline in 50% of RASTA group vs 67% of controls and at W48 in 32.4% vs 42%, respectively. No differences were found between HIV-1RNA levels at baseline and W48 within and between groups.ConclusionsSwitching successful therapy to raltegravir-based regimens may be associated with a decrease of the HIV-1 reservoir, as measured by peripheral blood cellular HIV-1DNA levels.