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. 2023 Jun 1;78(6):1510-1521.
doi: 10.1093/jac/dkad119.

Four days/week antiretroviral maintenance strategy (ANRS 170 QUATUOR): substudies of reservoirs and ultrasensitive drug resistance

Sidonie Lambert-Niclot  1   2 , Basma Abdi  1   3 , Jonathan Bellet  1 , Djeneba Fofana  1   2 , Pierre De Truchis  4 , Karine Amat  5 , Jean-Claude Alvarez  6 , Laure Surgers  1   7 , Clothilde Allavena  8 , Olivia Zaegell-Faucher  9 , Philippe Morlat  10 , Romain Palich  11 , Séverine Gibowski  12 , Dominique Costagliola  1 , Pierre-Marie Girard  7 , Roland Landman  13 , Lambert Assoumou  1 , Laurence Morand-Joubert  1   2 ; ANRS 170 QUATUOR study group
Collaborators, Affiliations

Four days/week antiretroviral maintenance strategy (ANRS 170 QUATUOR): substudies of reservoirs and ultrasensitive drug resistance

Sidonie Lambert-Niclot et al. J Antimicrob Chemother. .

Abstract

Background: In a 4 days/week (4/7 days) maintenance strategy (ANRS-170 QUATUOR trial), the virological impact of an intermittent strategy was assessed by ultrasensitive virological analyses of reservoirs and resistance.

Methods: HIV-1 total DNA, ultra-sensitive plasma viral load (USpVL) and semen VL were measured in the first 121 participants. Sanger and ultra-deep sequencing (UDS) were performed on the HIV-1 genome (Illumina technology) according to the ANRS consensus. A generalized estimation equation with a Poisson distribution was used to compare changes in the proportion of residual viraemia, detectable semen HIV RNA and HIV DNA within and between the two groups over time.

Results: The proportion of participants with residual viraemia at Day 0 (D0) and Week 48 (W48) was 16.7% and 25.0% in the 4/7 days group and 22.4% and 29.7% in the 7/7 days group, respectively (+8.3% versus +7.3%, P = 0.971). The proportion of detectable DNA (>40 copies/106 cells) at D0 and W48 was 53.7% and 57.4% in the 4/7 days group and 56.1% and 51.8% in the 7/7 days group, respectively (+3.7% versus -4.3%, P = 0.358). Semen HIV RNA was detectable (≥100 copies/mL) in 2.2% of participants at D0 and 4.5% at W48 in the 4/7 days group versus 6.1% and 9.1% in the 7/7 days group, respectively (+2.3% versus +3.0%, P = 0.743). Emerging resistance at failure was more frequent in the 4/7 days group detected by Sanger sequencing: 3/6 participants versus 1/4 in the 7/7 days group, and similar with the UDS assay: 5/6 versus 4/4, respectively.

Conclusions: These findings support the potency of a 4/7 days maintenance strategy on virological suppression at the reservoirs and emergent resistance level, including minority variants.

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