TILDA Testing for Viral Reservoir - Visconti Cohort - Treatment Break

Question

I was on treatment ARV treatment from almost week 2. I've read of the Visconti cohort who were able to stop treatment after 3 years and remain undetectable off medications. I want to try it but not sure. I want to make an educated decision.

I've heard of TILDA testing which can determine the reservoir. I don't know what other tests I can do to help me decide whether to try this or not. I'm willing to take a calculated risk, but not a gamble.

What should I do? What tests should I have done before I do this if I want to minimize my risks. What pre-treatments should I do to maximize my success?

Answer

The Visconti cohort consisted of 14 patients who were treated for HIV infection during acute infection and remained on HIV treatment for about 3 years, after which HIV treatment was stopped, and they were able to maintain CD4 counts and undetectable or very low HIV viral load levels without the need for additional HIV treatment.

The cohort was very small, and we don't know all the factors that could predict who would or would not rebound after stopping HIV treatment. The TILDA assay is an interesting approach to determine how much HIV virus can be cultured out of blood cells. This is currently a research assay and not commercially available. It is not clear whether the TILDA assay could predict who could stop treatment successfully like in the Visconti cohort.

You don't indicate any of the specifics of your case (current CD4, viral load, other ongoing medical conditions, etc) to comment. I suggest you discuss this further with your doctor about the pros and cons of such a decision.