By Bunmi Yekini
Initiating antiretroviral therapy (ART) within two years of contracting HIV significantly lowers the risk of viral blips, temporary increases in viral load—in people living with the virus, according to a new study published in Clinical Infectious Diseases.
The findings, drawn from data in the U.S. Military HIV Natural History Study, suggest that the HIV reservoir remains more malleable than previously thought, potentially opening a longer window for effective intervention.
“Our findings suggest that the window of opportunity to intervene with ART and achieve a beneficial effect in preventing blips may extend to two years after HIV acquisition,” the researchers said in the study.
Viral blips, defined as HIV RNA levels between 401 and 1000 copies/mL, are common among people on ART and are often attributed to random biological fluctuations. However, this study found that individuals who began ART earlier experienced fewer of these occurrences.
Out of 1,413 patients analyzed between 1996 and 2022, only 88 (6.2%) experienced viral blips after achieving viral suppression. Among these, most had only one blip, and very few had multiple episodes. The incidence of viral blips declined markedly over time, from 12.5 per 100 person-years in 1999 to 0.6 in 2020.
The study also highlighted key demographic and clinical differences between those who experienced blips and those who did not. Patients with blips tended to be older, delayed starting ART, and had poorer adherence to treatment. They were also more likely to have hepatitis B and lower CD4+ counts at the time of ART initiation.
“Shorter time from HIV acquisition to treatment, strong adherence to ART, and use of specific regimens like integrase inhibitors all played a role in reducing the likelihood of blips,” the researchers noted.
The use of unboosted protease inhibitors was associated with the highest risk of blips, while Black and Hispanic individuals, those aged 30–39 at ART initiation, and people with a history of hepatitis C infection were among groups less likely to experience them.
Although the study focused on U.S. military personnel, primarily young men, the researchers acknowledged that the findings might not generalize to more diverse populations. Still, they stressed the broader significance of early treatment.
“This reinforces the importance of early diagnosis and prompt initiation of ART, not just for long-term health outcomes but also for minimizing viral fluctuations that could have clinical or psychological implications,” they concluded.