Étude de l’établissement des réservoirs du VIH-1 et de l’impact de l’initiation précoce du traitement sur ces réservoirs chez l’enfant infecté par le VIH-1
The major barrier to eradicating HIV is the existence of cellular reservoirs of HIV, which escape the treatment and immune response of the host. This reservoir is established very early in the infection, typically leading to the destruction of a large number of CD4+ T cells. However, a small proportion of these cells return to quiescent state after integrating the viral genome. The size and evolution of the reservoir in adults have been well understood. However, we know less about the size and distribution of the HIV reservoir, and the impact of early initiation of combination antiretroviral therapy (cART) on it in the infant population. Our study is a part of the Early Pediatric Initiation Canada, Child Cure Cohort (EPIC4); a prospective, multicenter study, which enrolled 221 vertically HIV-1 infected children in nine Canadian pediatric centers. We hypothesize that very early initiation of cART in HIV-infected children would reduce the reservoir to its lowest levels, leading to better control of viral replication following a possible interruption of treatment. A strong positive correlation was observed between reservoir size in peripheral blood and both the age at initiation of cART and the age at which sustained viral suppression (SVS) was achieved. We found a strong negative correlation between the size of the viral reservoir and the proportion of life spent on effective cART or the proportion of life with SVS and CD4+ T lymphocytes count. This study shows that starting cART within 6 months from birth is a predictor of faster and more sustained virological suppression in infants. Our findings suggest that early cART initiation in infants and long-term viral suppression are key factors leading to limited viral reservoir size. Furthermore, we established for the first time that the size of the inducible HIV-1 reservoir in peripheral blood CD4+ T lymphocytes of children, quantified by the prostratin analogue stimulation test, correlates with the size obtained using proviral DNA measurement. Thus, we have validated a new inducible reservoir measurement technique that is fast, less expensive, and, importantly requires a lower blood volume. This assay could be very promissing for evaluating inducible HIV-1 reservoirs in pediatric HIV-1 studies.
HIV reservoir Infants Early treatment Virological suppression HIV-1 DNA Inducible RNA Prostratin