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Recommendations for measuring HIV reservoir size in cure-directed clinical trials.

ABSTRACT: Therapeutic strategies are being clinically tested either to eradicate latent HIV reservoirs or to achieve virologic control in the absence of antiretroviral therapy. Attaining this goal will require a consensus on how best to measure the numbers of persistently infected cells with the potential to cause viral rebound after antiretroviral-therapy cessation in assessing the results of cure-directed strategies in vivo. Current measurements assess various aspects of the HIV provirus and its functionality and produce divergent results. Here, we provide recommendations from the BEAT-HIV Martin Delaney Collaboratory on which viral measurements should be prioritized in HIV-cure-directed clinical trials.

SUBMITTER: Abdel-Mohsen M

PROVIDER: S-EPMC7703694 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Recommendations for measuring HIV reservoir size in cure-directed clinical trials.

Abdel-Mohsen Mohamed M Richman Douglas D Siliciano Robert F RF Nussenzweig Michel C MC Howell Bonnie J BJ Martinez-Picado Javier J Chomont Nicolas N Bar Katharine J KJ Yu Xu G XG Lichterfeld Mathias M Alcami Jose J Hazuda Daria D Bushman Frederic F Siliciano Janet D JD Betts Michael R MR Spivak Adam M AM Planelles Vicente V Hahn Beatrice H BH Smith Davey M DM Ho Ya-Chi YC Buzon Maria J MJ Gaebler Christian C Paiardini Mirko M Li Qingsheng Q Estes Jacob D JD Hope Thomas J TJ Kostman Jay J Mounzer Karam K Caskey Marina M Fox Lawrence L Frank Ian I Riley James L JL Tebas Pablo P Montaner Luis J LJ

Nature medicine 20200907 9

Therapeutic strategies are being clinically tested either to eradicate latent HIV reservoirs or to achieve virologic control in the absence of antiretroviral therapy. Attaining this goal will require a consensus on how best to measure the numbers of persistently infected cells with the potential to cause viral rebound after antiretroviral-therapy cessation in assessing the results of cure-directed strategies in vivo. Current measurements assess various aspects of the HIV provirus and its functio ...[more]

PMID: 32895573

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Project description:Monitoring the efficacy of novel reservoir-reducing treatments for HIV is challenging. The limited ability to sample and quantify latent infection means that supervised antiretroviral therapy (ART) interruption studies are generally required. Here we introduce a set of mathematical and statistical modeling tools to aid in the design and interpretation of ART-interruption trials. We show how the likely size of the remaining reservoir can be updated in real-time as patients continue off treatment, by combining the output of laboratory assays with insights from models of reservoir dynamics and rebound. We design an optimal schedule for viral load sampling during interruption, whereby the frequency of follow-up can be decreased as patients continue off ART without rebound. While this scheme can minimize costs when the chance of rebound between visits is low, we find that the reservoir will be almost completely reseeded before rebound is detected unless sampling occurs at least every two weeks and the most sensitive viral load assays are used. We use simulated data to predict the clinical trial size needed to estimate treatment effects in the face of highly variable patient outcomes and imperfect reservoir assays. Our findings suggest that large numbers of patients-between 40 and 150-will be necessary to reliably estimate the reservoir-reducing potential of a new therapy and to compare this across interventions. As an example, we apply these methods to the two "Boston patients", recipients of allogeneic hematopoietic stem cell transplants who experienced large reductions in latent infection and underwent ART-interruption. We argue that the timing of viral rebound was not particularly surprising given the information available before treatment cessation. Additionally, we show how other clinical data can be used to estimate the relative contribution that remaining HIV+ cells in the recipient versus newly infected cells from the donor made to the residual reservoir that eventually caused rebound. Together, these tools will aid HIV researchers in the evaluating new potentially-curative strategies that target the latent reservoir.

Dataset Information

Recommendations for measuring HIV reservoir size in cure-directed clinical trials.

Publications

Recommendations for measuring HIV reservoir size in cure-directed clinical trials.

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