ArticleCommunications medicine2025
Ultra-low level HIV p24 drives immune activation in antiretroviral therapy-treated people living with HIV.
Article in Communications medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
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The trial behind it
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Who cites it
4 citing papers in PubMed.
- Persistent CD8+ T-cell activation (HLA-DR/CD38) as an immunological marker in antiretroviral-treated human immunodeficiency virus-1 patients: A cross-sectional study.The Journal of international medical research · 2026Article
- Article
- Different Trends of Immune Activation Markers When Switching to Either Oral or Injectable Dual Antiretroviral Therapy Based on Integrase Inhibitors in People Living with HIV.Pathogens (Basel, Switzerland) · 2026Article
- Residual HIV activity and host immunometabolic remodeling during antiretroviral therapy: implications for cardiovascular-kidney-metabolic risk.Frontiers in immunology · 2026Review
Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
backgroundDespite effective antiretroviral therapy (ART), people living with HIV (PLWH) often exhibit persistent immune activation, the mechanisms of which remain unclear. Increasing evidence suggests that residual low-level viremia and ongoing viral protein expression may persist even under long-term suppressive ART, underscoring the need for a better understanding of residual HIV persistence.
methodsWe therefore optimized a digital single-molecule array (Simoa®) technology to detect ultra-low levels of HIV p24 antigen in plasma, achieving femtogram sensitivity. In addition, we used flow cytometry to analyze HIV-specific T cell responses.
resultsHere we show that in a cohort of 108 participants with chronic HIV on long-term ART with HIV-1 RNA < 30 copies/mL for >4 years, p24 is detectable (17 - 370 fg/mL) in 42. Dual protease inhibitor therapy is associated with significantly lower p24 levels (p < 0.05), while age, ART duration or CD4/CD8 ratio show no effect. Monitoring 41 individuals who initiated ART during acute HIV, p24 remains detectable in 20% after two years. Although p24 correlates with viral RNA early in ART (r = 0.83, p < 0.0001), this association is lost after two months (r = 0.20, p = 0.21). Importantly, p24+ individuals show significantly higher frequencies of PD-1 + , CD38 + , and CD38 + HLA-DR + CD8 T cells (p < 0.01; p < 0.05), alongside enhanced TNF-α and CD107a responses to HIV Gag (p < 0.01; p < 0.05).
conclusionsTo best of our knowledge, our findings provide the first large-cohort evidence of low-level p24 persistence during suppressive ART and suggest that ongoing p24 production may contribute to residual immune activation in treated PLWH.
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Registered trials
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