Work

Increases in total HIV-1 nucleic acid in whole blood precede plasma RNA rebound during pediatric analytical treatment interruption

Year: 2026

Type: article

Abstract: OBJECTIVES: In the absence of reliable biomarkers, analytical treatment interruption (ATI) is needed to evaluate HIV-1 cure/remission strategies. Children living with HIV-1 may have high potential to achieve cure/remission due to very-early antiretroviral therapy (ART) initiation combined with early-life immunity. However, pediatric ATI safety monitoring requires frequent blood sampling for early plasma viral rebound detection to facilitate prompt ART resumption. DESIGN: We hypothesized that viral rebound during ATI would be detected earlier by point-of-care (PoC) total HIV-1 nucleic acid (TNA) measurement, which quantifies both HIV-1 RNA and DNA, than via standard laboratory assays of plasma HIV-1 RNA. Therefore, viral rebound during pediatric ATI studies could be detected earlier via a practical and user-friendly approach. METHODS: Nineteen very-early ART-treated children underwent ATI. Sixteen experienced plasma HIV-1 viral rebound. PoC TNA testing with the Cepheid GeneXpert HIV-1 Qual XC assay, requiring 100 μl of whole blood and 2 h turnaround time (TAT), was compared with standard plasma HIV-1 RNA quantification (Aptima Quant), requiring 500 μl of whole blood and 30 h TAT. RESULTS: GeneXpert TNA Ct values and plasma HIV-1 RNA were strongly negatively correlated ( r = -0.88, P < 0.0001). In all 27 instances where viral rebound was detected by plasma HIV-1 RNA testing, TNA was also detected. In 12 instances, TNA was detected prior to any plasma RNA rebound. There were no instances where plasma rebound was detected prior to TNA detection ( P = 2 x 10 -15 ). CONCLUSION: PoC HIV-1 TNA testing offers a more rapid and lower-volume method to detect viral rebound in pediatric ATI, enhancing safety monitoring and timely ART reinitiation.

Source: AIDS

DOI: 10.1097/qad.0000000000004506