Predicted drug susceptibility in women at enrolment and at delivery.

<p>Predicted drug susceptibility in women at enrolment and at delivery.</p

HIV resistant mutations in HIV-infected pregnant women at enrolment, at delivery and acquired during pregnancy.

<p>HIV resistant mutations in HIV-infected pregnant women at enrolment, at delivery and acquired during pregnancy.</p

Baseline characteristics at enrolment of study participants (N = 113).

<p>Baseline characteristics at enrolment of study participants (N = 113).</p

Study profile.

<p>Study profile.</p

Frequency of resistance mutations by drug category at enrolment, at delivery and acquired during pregnancy.

<p>Frequency of resistance mutations by drug category at enrolment, at delivery and acquired during pregnancy.</p

Characteristics of women at enrolment and at delivery.

<p>Characteristics of women at enrolment and at delivery.</p

HIV-1 Tropism Testing in Subjects Achieving Undetectable HIV-1 RNA: Diagnostic Accuracy, Viral Evolution and Compartmentalization

<div><p>Background</p><p>Technically, HIV-1 tropism can be evaluated in plasma or peripheral blood mononuclear cells (PBMCs). However, only tropism testing of plasma HIV-1 has been validated as a tool to predict virological response to CCR5 antagonists in clinical trials. The preferable tropism testing strategy in subjects with undetectable HIV-1 viremia, in whom plasma tropism testing is not feasible, remains uncertain.</p><p>Methods & Results</p><p>We designed a proof-of-concept study including 30 chronically HIV-1-infected individuals who achieved HIV-1 RNA <50 copies/mL during at least 2 years after first-line ART initiation. First, we determined the diagnostic accuracy of 454 and population sequencing of gp120 V3-loops in plasma and PBMCs, as well as of MT-2 assays before ART initiation. The Enhanced Sensitivity Trofile Assay (ESTA) was used as the technical reference standard. 454 sequencing of plasma viruses provided the highest agreement with ESTA. The accuracy of 454 sequencing decreased in PBMCs due to reduced specificity. Population sequencing in plasma and PBMCs was slightly less accurate than plasma 454 sequencing, being less sensitive but more specific. MT-2 assays had low sensitivity but 100% specificity. Then, we used optimized 454 sequence data to investigate viral evolution in PBMCs during viremia suppression and only found evolution of R5 viruses in one subject. No <i>de novo</i> CXCR4-using HIV-1 production was observed over time. Finally, Slatkin-Maddison tests suggested that plasma and cell-associated V3 forms were sometimes compartmentalized.</p><p>Conclusions</p><p>The absence of tropism shifts during viremia suppression suggests that, when available, testing of stored plasma samples is generally safe and informative, provided that HIV-1 suppression is maintained. Tropism testing in PBMCs may not necessarily produce equivalent biological results to plasma, because the structure of viral populations and the diagnostic performance of tropism assays may sometimes vary between compartments. Thereby, proviral DNA tropism testing should be specifically validated in clinical trials before it can be applied to routine clinical decision-making.</p></div

Accuracy of Tropism Assays Relative to the Enhanced-Sensitivity Trofile™ Assay.^{^a}

a<p>Values are mean percentages (95% confidence interval of the mean), calculated assuming a binomial distribution of the data.</p>b<p><i>G2P FPR</i>, Geno2Pheno_[coreceptor] false positive rate used for population and 454 sequencing to assign CXCR4 use . The Geno2Pheno_[coreceptor] clonal model was always used.</p>c<p><i>MT-2</i>, Direct cocultivation of patient-derived peripheral blood mononuclear cells with MT-2 cells.</p>d<p><i>PPV</i>, Positive Predictive Value.</p>e<p><i>NPV</i>, Negative Predictive Value.</p>f<p>“Accuracy” is defined as: (True positives + True negatives)/Total.</p

Selection of a CXCR4-using variant above the 454 sequencing error threshold during persistent viremia suppression in Subject 26.

<p><b><i>Panel A, antiretroviral treatment history, virological and immunological evolution</i></b><b>.</b> Continuous line, HIV-1 RNA levels; dashed line, CD4+ counts; horizontal bars, time period during which a given antiretroviral drug was prescribed. Vertical lines indicate the timepoints when 454 sequencing was performed. LPVr, lopinavir/ritonavir; AZT, zidovudine; ddI, didanosine; RAL, raltegravir. <b><i>Panel B, maximum likelihood nucleotide-based phylogenetic tree</i></b> including V3-loop haplotypes present at a frequency ≥0.6% in the virus population in plasma (triangles), PBMCs before therapy initiation (circles) and PBMCs after persistent viremia suppression (squares). The tree is rooted at the most frequent plasma sequence before antiretroviral treatment initiation. Filled symbols show predicted CXCR4-using viruses; open symbols show predicted CCR5-using viruses. Symbol size increases proportionally to the V3-loop haplotype frequency in the virus population in 10% intervals. Node reliability was tested using 1000 bootstraps; bootstrap values ≥50% are shown. The V3-loop aminoacid sequence translation is shown next to each taxon. Aminoacid changes relative to the predominant sequence in plasma are highlighted in bold and underlined. Gaps correspond to aminoacid indeterminations. A Geno2Pheno _[coreceptor] false positive rate (FPR) equal or lower than 10% was used to define CXCR4 use. The actual false positive rate of each sequence is shown. *Sequence #2 was identical to one detected in 0.04% of PBMC-associated viruses, below the error threshold, before treatment initiation.</p

Structured treatment interruption (STI) increases levels of Env specific antibodies.

<p>Mean flourescence intensity (MFI) of stained MOLT cells expressing trimeric Env (from isolates HIV-1_NL4.3 and HIV-1_BaL) or lacking Env expression (uninfected) is show for plasma samples obtained at the start (STI-w0) or after 12 weeks (STI-w12) into STI in the placebo (white, n = 10) or the vaccinated (grey, n = 15) group. P-values for Wilcoxon paired test comparing w0-STI values to w12-STI are shown on top of the figure.</p