Absence of detectable viremia after treatment cessation in perinatally HIV-infected (PHIV) children suggests that early initiation of highly active combination of antiretroviral therapy (HAART) may lead to functional cure. By stopping the viral replication, the early virostatic treatment may prevent the development of the HIV-1-specific antibody responses and limit the establishment of the viral reservoir. Here we describe the factors associated with the anti-gp41 antibodies activity and the viral reservoir size in PHIV HAART-treated children. Our second objective was to identify global HIV seroreversions.
This transversal prospective study involved 97 PHIV HAART-treated children with virological suppression (HIV-1 RNA plasma ≤ 50 copies/mL). It took place in Gabriel Touré hospital, in Bamako, Mali, between August 2013 and April 2014. We measured the anti-gp41 antibodies activity (binding to the immunodominant epitope), determined by an enzyme-immunoassay (ELISA), and the quantification of antibodies to HIV by the Architect ELISA (Abbott). The size of viral reservoir was determined by measuring HIV blood cell associated total DNA.
The PHIV children studied had a median of 9.8 years of age (IQR = 7.0 – 13.1) at time of inclusion. In median, they had started HAART at 3.3 years of age (IQR = 1.9 – 7) and were on HAART for the past 5.4 years (IQR = 3.5 – 7). The median level of total HIV DNA was 445 copies/106 cells (IQR = 187 – 914), the median anti-gp41 antibodies activity was 0.29 UA (IQR = 0.18 – 0.75). A low activity of anti-gp41 antibodies was associated with a younger age at treatment initiation (p = 0.01). No association was found between anti-gp41 antibodies and HIV DNA (p = 0.17). The 9 children having an HIV DNA under the threshold (< 66 copies/106 cells) tended to have a lower anti-gp41 antibodies activity versus children with an HIV DNA > 66 copies//106 cells (p = 0.11). Overall, eight seroreversions were identified (negative Architect ELISA) in which 2 children had an HIV DNA under the threshold (1 detectable and 1 undetectable) and a low anti-gp41 antibodies activity.
This study may be helpful to identify candidates with low viral reservoir and low antibodies level for future strategies aiming at reduce the burden of antiretroviral therapy or control the HIV reservoir in children.