# Long-term effect of temporary ART initiated during primary HIV-1 infection on viral persistence

## TL;DR

Starting ART early in HIV-1 infection may have lasting effects on reducing the virus's persistence even after treatment stops.

## Contribution

The study shows that temporary early ART reduces HIV-1 proviral diversity and viral persistence markers long-term.

## Key findings

- Early ART is associated with lower HIV-1 proviral sequence diversity and better CD4/CD8 ratio restoration.
- Levels of HIV-1 persistence markers during chronic infection are lower in those pre-treated during primary infection.
- Intact HIV-1 DNA correlates negatively with HIV-specific T-cell responses during chronic ART.

## Abstract

Initiation of antiretroviral therapy (ART) during primary HIV-1 infection (PHI) has been proposed to limit the formation of HIV-1 reservoirs. However, it remains unknown whether temporary ART initiated during PHI has a long-term effect on viral persistence. Here, we longitudinally quantify HIV-1 persistence markers and immunological parameters in the participants (n = 64) of a randomized controlled trial comparing 24 or 60 weeks of temporary ART vs. no treatment during PHI, who subsequently (re)initiated ART during chronic HIV-1 infection (CHI) after a median period of 116 weeks without treatment (ISRCTN59497461). Levels of several HIV-1 persistence markers (cell-associated unspliced RNA, total DNA, and intact DNA) do not significantly differ and strongly positively correlate between early and CHI ART periods in the same participants. Early ART is associated with lower HIV-1 proviral sequence diversity and superior restoration of the CD4/CD8 ratio, as well as lower levels of monocyte activation markers, compared to CHI ART, in the same participants. At CHI ART, intact HIV-1 DNA negatively correlates with HIV-specific T-cell responses. Finally, levels of HIV-1 persistence markers during CHI ART are lower in participants who had been pre-treated during PHI, indicating a long-term suppressive effect of temporary early ART on the persistence of HIV-1 reservoir.

Initiating antiretroviral therapy (ART) during primary HIV-1 infection (PHI) may influence long-term viral persistence, yet its enduring effects remain unclear. Here, Pasternak and colleagues demonstrate that temporary ART started early in infection reduces HIV-1 proviral diversity and monocyte activation, and sustains lower levels of viral persistence markers, suggesting a lasting suppressive impact on the HIV-1 reservoir.