Randomized, Controlled Trial of Therapy Interruption in Chronic HIV-1 Infection

BACKGROUND: Approaches to limiting exposure to antiretroviral therapy (ART) drugs are an active area of HIV therapy research. Here we present longitudinal follow-up of a randomized, open-label, single-center study of the immune, viral, and safety outcomes of structured therapy interruptions (TIs) in patients with chronically suppressed HIV-1 infection as compared to equal follow-up of patients on continuous therapy and including a final therapy interruption in both arms. METHODS AND FINDINGS: Forty-two chronically HIV-infected patients on suppressive ART with CD4 counts higher than 400 were randomized 1:1 to either (1) three successive fixed TIs of 2, 4, and 6 wk, with intervening resumption of therapy with resuppression for 4 wk before subsequent interruption, or (2) 40 wk of continuous therapy, with a final open-ended TI in both treatment groups. Main outcome was analysis of the time to viral rebound (>5,000 copies/ml) during the open-ended TI. Secondary outcomes included study-defined safety criteria, viral resistance, therapy failure, and retention of immune reconstitution. There was no difference between the groups in time to viral rebound during the open-ended TI (continuous therapy/single TI, median [interquartile range] = 4 [1–8] wk, n = 21; repeated TI, median [interquartile range] = 5 [4–8] wk, n = 21; p = 0.36). No differences in study-related adverse events, viral set point at 12 or 20 wk of open-ended interruption, viral resistance or therapy failure, retention of CD4 T cell numbers on ART, or retention of lymphoproliferative recall antigen responses were noted between groups. Importantly, resistance detected shortly after initial viremia following the open-ended TI did not result in a lack of resuppression to less than 50 copies/ml after reinitiation of the same drug regimen. CONCLUSION: Cycles of 2- to 6-wk time-fixed TIs in patients with suppressed HIV infection failed to confer a clinically significant benefit with regard to viral suppression off ART. Also, secondary analysis showed no difference between the two strategies in terms of safety, retention of immune reconstitution, and clinical therapy failure. Based on these findings, we suggest that further clinical research on the long-term consequences of TI strategies to decrease drug exposure is warranted

Study Design (Phases I and II)

<p>Study Design (Phases I and II)</p

T Cell Subsets and Recall Lymphoproliferative Response at the End of Phase I

<p>End of phase I values for each arm are summarized (median and first and third quartiles) in the stacked figures showing from top to bottom: CD4 T cells/μl, CD4%, CD4⁻CD45RA⁺CD62L⁺% (naïve phenotype), CD8 T cells/μl, CD8%, and C. albicans lymphoproliferative response (shown as stimulation Index, SI). Unpaired <i>p</i> values for each variable are shown above corresponding bracket.</p

Lack of a Difference between Groups in Plasma HIV-1 RNA during Phase II

<p>Top panel shows Kaplan-Meyer plot summarizing time to a viral load of more than 5,000 copies/ml in both arms. Second panel shows viral load (mean ± standard error) per arm during 27 wk of TI (median time of phase II). Bottom table shows number of patients at time points shown for viral load in the second panel; the decrease in viral load over time is due to the reinitiation of therapy in patients with higher viral loads.</p

CD4 T Cells/μl and T Cell Recall Lymphoproliferative Response during Sequential TIs in Phase I

<p>Shown are data from the repeated interruptions arm. Panels show the TI initiation visit and TI end visit of each sequential TI inclusive of the initiation visit for phase II (open-ended TI).</p

Study Flow

<p>Study Flow</p

Measurement of b jet shapes in proton-proton collisions at root s=5.02 TeV

We present the first study of charged-hadron production associated with jets originating from b quarks in proton-proton collisions at a center-of-mass energy of 5.02 TeV. The data sample used in this study was collected with the CMS detector at the CERN LHC and corresponds to an integrated luminosity of 27.4 pb(-1). To characterize the jet substructure, the differential jet shapes, defined as the normalized transverse momentum distribution of charged hadrons as a function of angular distance from the jet axis, are measured for b jets. In addition to the jet shapes, the per-jet yields of charged particles associated with b jets are also quantified, again as a function of the angular distance with respect to the jet axis. Extracted jet shape and particle yield distributions for b jets are compared with results for inclusive jets, as well as with the predictions from the pythia and herwig++ event generators

Measurements of the differential cross sections of the production of Z plus jets and gamma plus jets and of Z boson emission collinear with a jet in pp collisions at root s=13 TeV

Measurements of the differential cross sections of Z + jets and gamma + jets production, and their ratio, are presented as a function of the boson transverse momentum. Measurements are also presented of the angular distribution between the Z boson and the closest jet. The analysis is based on pp collisions at a center-of-mass energy of 13 TeV corresponding to an integrated luminosity of 35.9 fb(-1) recorded by the CMS experiment at the LHC. The results, corrected for detector effects, are compared with various theoretical predictions. In general, the predictions at higher orders in perturbation theory show better agreement with the measurements. This work provides the first measurement of the ratio of the differential cross sections of Z + jets and gamma + jets production at 13 TeV, as well as the first direct measurement of Z bosons emitted collinearly with a jet