短期抗逆转录病毒疗法中断对整合 HIV DNA 水平的影响。

Effect of Short-Term Antiretroviral Therapy Interruption on Levels of Integrated HIV DNA.

机构信息

Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.

University of Pennsylvania, Philadelphia, Pennsylvania, USA.

出版信息

J Virol. 2018 May 29;92(12). doi: 10.1128/JVI.00285-18. Print 2018 Jun 15.

Abstract

Analytic treatment interruption (ATI) studies are required to evaluate strategies aimed at achieving ART-free HIV remission, but the impact of ATI on the viral reservoir remains unclear. We validated a DNA size selection-based assay for measuring levels of integrated HIV DNA and applied it to assess the effects of short-term ATI on the HIV reservoir. Samples from participants from four AIDS Clinical Trials Group ATI studies were assayed for integrated HIV DNA levels. Cryopreserved peripheral blood mononuclear cells (PBMCs) were obtained for 12 participants with available samples pre-ATI and approximately 6 months after ART resumption. Four participants also had samples available during the ATI. The median duration of ATI was 12 weeks. Validation of the HIV integrated DNA size-exclusion (HIDE) assay was performed using samples spiked with unintegrated HIV DNA, HIV-infected cell lines, and participant PBMCs. The HIDE assay eliminated 99% of unintegrated HIV DNA species and strongly correlated with the established Alu- assay. For the majority of individuals, integrated DNA levels increased during ATI and subsequently declined upon ART resumption. There was no significant difference in the levels of integrated HIV DNA between the pre- and post-ATI time points, with a median ratio of post- to pre-ATI HIV DNA levels of 0.95. Using a new integrated HIV DNA assay, we found minimal change in the levels of integrated HIV DNA in participants who underwent an ATI, followed by 6 months of ART. This suggests that short-term ATI can be conducted without a significant impact on the levels of integrated proviral DNA in the peripheral blood. Interventions aimed at achieving sustained antiretroviral therapy (ART)-free HIV remission require treatment interruption trials to assess their efficacy. However, these trials are accompanied by safety concerns related to the expansion of the viral reservoir. We validated an assay that uses an automated DNA size-selection platform for quantifying levels of integrated HIV DNA and is less sample- and labor-intensive than current assays. Using stored samples from AIDS Clinical Trials Group studies, we found that short-term ART discontinuation had minimal impact on integrated HIV DNA levels after ART resumption, providing reassurance about the reservoir effects of short-term treatment interruption trials.

摘要

分析性治疗中断 (ATI) 研究对于评估旨在实现无抗逆转录病毒治疗 (ART) 的 HIV 缓解的策略是必要的,但 ATI 对病毒储存库的影响尚不清楚。我们验证了一种基于 DNA 大小选择的测定法,用于测量整合 HIV DNA 的水平,并应用该方法评估短期 ATI 对 HIV 储存库的影响。从四项 AIDS 临床试验组 ATI 研究的参与者中采集样本,用于测定整合 HIV DNA 水平。对于有可用样本的 12 名参与者,获得了冷冻保存的外周血单核细胞 (PBMC),这些样本分别在 ATI 前和 ART 恢复后大约 6 个月时采集。四名参与者在 ATI 期间也有样本。ATI 的中位持续时间为 12 周。使用含有未整合 HIV DNA、感染 HIV 的细胞系和参与者 PBMC 的样本对 HIV 整合 DNA 大小排除 (HIDE) 测定进行了验证。HIDE 测定法消除了 99%的未整合 HIV DNA 种类,并与既定的 Alu 测定法高度相关。对于大多数个体,在 ATI 期间整合 DNA 水平增加,随后在 ART 恢复时下降。在 ATI 前和 ATI 后时间点之间,整合 HIV DNA 水平没有显著差异,整合 HIV DNA 水平的中位数比值为 0.95。使用新的整合 HIV DNA 测定法,我们发现接受 ATI 的参与者的整合 HIV DNA 水平变化很小,随后进行了 6 个月的 ART。这表明,短期 ATI 可以在不显著影响外周血中整合前病毒 DNA 水平的情况下进行。旨在实现持续抗逆转录病毒治疗 (ART) 无 HIV 缓解的干预措施需要中断治疗试验来评估其疗效。然而,这些试验伴随着与病毒储存库扩大相关的安全问题。我们验证了一种使用自动化 DNA 大小选择平台定量整合 HIV DNA 水平的测定法,与当前测定法相比,该方法的样本和劳动力需求更少。使用 AIDS 临床试验组研究的存储样本,我们发现 ART 恢复后,短期 ART 中断对整合 HIV DNA 水平的影响很小,这为短期治疗中断试验对病毒储存库的影响提供了保证。

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