Abstract Body


Initiation of antiretrovirals (ART) during acute HIV infection reduces viral reservoirs with improved long term virologic control; there is limited data on youth. HIV reservoir decay in youth treated during acute HIV infection (A) may be greater than in those treated with non-acute infection (NA). ATN 147 identified A or NA HIV-infected youth (12-24 yr.) assessing HIV plasma RNA PCR, DNA digital drop (dd) PCR and HIV antibody from baseline (BL) to 24 mo.


Youth newly diagnosed with HIV infection initiated ART in Los Angeles and New Orleans. Acute infection was defined as Fiebig stage I-V on HIV Western blot (WB) at BL. Fiebig stage VI defined NA infection. Blood was collected over 24 mo. with viral suppression (VS) defined as plasma HIV RNA 20 copies/ml. HIV DNA ddPCR on PBMC and WB were performed at BL, 12, 24 mo. Statistical comparisons at different timepoints/between groups used log-transformed DNA & RNA values in a mixed effect model.


103 youth enrolled with mean age of 20.8 yr. (range:16-24); 60% identified as black, 25% Latino, 8% white, 7% Asian/Native American; 90% identified as cis-male, 2% cis-female, 5% trans-female, 3% gender nonconforming; 95% reported same gender/bisexual orientation. ART was initiated within 24 hours in 78%, within 1 week in 88%. At BL, 36 (35%) were A and 67 (65%) NA. Median virus load (VL) at BL was 104,650 (A) and 32,334 cps/ml (NA), p < 0.001 & at 4mo. 30 (A) and 20 cps/ml (NA), p =0.815. By 12 & 24 mo. both A and NA had median VL of 20 cps/ml, p=NS. At 4, 12, 24 mo., 50/82 (61%), 52/76 (68%), 41/57 (72%) youth achieved VS. Median ddPCR copies/million PBMCs for youth over time (BL,12,24 mo.) was 844, 192, 127, p < 0.001. For A vs. NA youth, BL,12,24 mo. ddPCR values were 1448 vs. 633, 188 vs. 192, 148 vs. 106, p=0.66. Median dd PCR for VS youth at 12 mo. was 115 vs. 485 in non-VS youth, p < 0.001; at 24 mo. 107 (VS) vs. 202 (non-VS), p < 0.001. Negative/indeterminate (NI) WB occurred in 32% of the cohort at 12 & 35% at 24 mo. NI WB was associated with A status at 12 & 24 mo. (OR 11.5; 95%CI:3.88-34.08). VL suppression at 12 & 24 mo. was not associated with NI WB (OR 2.96; 95% CI 0.91-9.66).


Early ART induced sustained VS in 68% of youth by 12 mo., significantly reducing HIV DNA and antibody levels. Within 4 mo. of ART, VS was similar in both A and NA youth. HIV DNA decay was similar in A and NA youth with VS. Acutely treated youth were less likely to maintain positive HIV WB.

Median HIV RNA, HIV DNA, and HIV Antibody Responses to Early ART Treatment