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Background  The effect of ART initiation time on HIV-1 DNA reservoir in chronically infected individuals is not well understood. Determining the potential influencing factors associated with a low HIV-1 DNA level in chronic infection is an important step toward drug-free control.    Methods  A prospective study included 444 chronically HIV-infected adults was performed. Participants were divided into two groups: early initiation group (EIG) or delayed initiation group (DIG) based on their baseline CD4 count; 350 to 500 and < 350 cells/mm 3 , respectively. Total HIV-1 DNA was measured by quantitative PCR. Using the Mann-Whitney U test, the HIV-1 DNA level at week 48 was compared between the two groups. The influencing factors of the HIV-1 DNA and factors associated with achieving a low HIV-1 level at week 48 were analyzed.    Results  The HIV-1 DNA at week 48 in EIG was significantly lower than in DIG [2.12 (1.80–2.51) vs 2.58 (2.21–2.87) log 10  copies/10 6 peripheral blood mononuclear cells (PBMCs);  p  = 0.001]. Early ART initiation was positively associated with lower HIV-1 DNA at week 48 ( p  = 0.025). Similarly, baseline HIV-1DNA ( p  = 0.001) was positively associated with HIV-1DNA at week 48 and baseline CD4/CD8 ratio ( p  = 0.001) was inversely associated with HIV-1DNA at week 48. Early ART initiation ( p  = 0.003) and baseline HIV-1 DNA level ( p  < 0.001) were positively associated with achieving HIV-1 DNA < 100 copies/10 6  PBMCs at week 48.    Conclusion  Early ART initiation is positively associated with a smaller size of viral reservoir and a higher possibility of achieving a low HIV-1DNA level at week 48 in Chinese chronically HIV-1 infected adult.    Trial registration   NCT01844297 ; Registered 1 May, 2013.

bmc infectious diseases

The effects of antiretroviral therapy initiation time on HIV reservoir size in Chinese chronically HIV infected patients: a prospective, multi-site cohort study