- Barbehenn, Alton;
- Shi, Lei;
- Shao, Junzhe;
- Hoh, Rebecca;
- Hartig, Heather;
- Pae, Vivian;
- Sarvadhavabhatla, Sannidhi;
- Donaire, Sophia;
- Sheikhzadeh, Caroline;
- Milush, Jeffrey;
- Laird, Gregory;
- Mathias, Mignot;
- Ritter, Kristen;
- Peluso, Michael;
- Martin, Jeffrey;
- Hecht, Frederick;
- Pilcher, Christopher;
- Cohen, Stephanie;
- Buchbinder, Susan;
- Havlir, Diane;
- Gandhi, Monica;
- Henrich, Timothy;
- Hatano, Hiroyu;
- Wang, Jingshen;
- Deeks, Steven;
- Lee, Sulggi
Despite antiretroviral therapy (ART), HIV persists in latently-infected cells (the HIV reservoir) which decay slowly over time. Here, leveraging >500 longitudinal samples from 67 people living with HIV (PLWH) treated during acute infection, we developed a mathematical model to predict reservoir decay from peripheral CD4 + T cells. Nonlinear generalized additive models demonstrated rapid biphasic decay of intact DNA (week 0-5: t1/2 ~ 2.83 weeks; week 5-24: t1/2 ~ 15.4 weeks) that extended out to 1 year. These estimates were ~5-fold faster than prior decay estimates among chronic treated PLWH. Defective DNA had a similar biphasic pattern, but data were more variable. Predicted intact and defective decay rates were faster for PLWH with earlier timing of ART initiation, higher initial CD4 + T cell count, and lower pre-ART viral load. In this study, we advanced our limited understanding of HIV reservoir decay at the time of ART initiation, informing future curative strategies targeting this critical time.