{"doi":"10.1093/cid/ciaf103","title":"Antiretroviral Therapy Within 2 Years of HIV Acquisition Is Associated With Fewer Viral Blips: A Retrospective Analysis of More Than 20 Years of Data From the US Military HIV Natural History Study","abstract":"BACKGROUND: Viral blips have been associated with larger reservoir size and slower decay. Earlier antiretroviral therapy (ART) initiation may decrease the risk of blips. METHODS: We analyzed participants from the US Military HIV Natural History Study with an estimated human immunodeficiency virus (HIV) seroconversion date, viral suppression ≤400 copies/mL within 1 year after starting ART, and at least 3 HIV RNA measurements after suppression. A blip was defined as HIV RNA 401-1000 copies/mL preceded and followed by HIV RNA ≤400 copies/mL without changing ART. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for factors potentially associated with the time from viral suppression to first blip. RESULTS: From 1996 through 2022, among 1413 participants on stable suppressive ART, 88 (6.2%) had at least one blip, including 68 (77.3%) with only a single blip. The overall incidence was 1.2 blips per 100 person-years (95% CI: .9-1.4). In multivariable modeling, ART initiation within 24 months of estimated HIV acquisition was independently associated with decreased hazard of viral blips compared with ART initiation after more than 24 months (0-6 months HR: 0.29 and 95% CI: .18-.48; 6-12 months HR: 0.43 and 95% CI: .31-.59; 12-24 months HR: 0.46 and 95% CI: .35-.60). CONCLUSIONS: Participants who initiated ART within 2 years of HIV acquisition had lower hazard of blips, potentially reflecting smaller reservoir size and suggesting reservoir plasticity that extends beyond the acute phase of HIV.","journal":"Clinical Infectious Diseases","year":2025,"id":530502,"datarank":0.26876392038420827,"base_score":1.791759469228055,"endowment":1.791759469228055,"self_citation_contribution":0.26876392038420827,"citation_network_contribution":0.0,"self_endowment_contribution":0.26876392038420827,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":5,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9256,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":967633,"name":"Hsing-Chuan Hsieh","orcid":"0000-0001-9374-5973","position":1,"is_corresponding":false},{"id":1410184,"name":"Xun Wang","orcid":"0009-0004-0330-9473","position":2,"is_corresponding":false},{"id":896997,"name":"Xiuping Chu","orcid":"0000-0003-2628-290X","position":3,"is_corresponding":false},{"id":957025,"name":"Britt Gayle","orcid":"0000-0001-5729-6090","position":4,"is_corresponding":false},{"id":670641,"name":"Catherine M Berjohn","orcid":"0000-0001-5655-8183","position":5,"is_corresponding":false},{"id":449837,"name":"Jason M Blaylock","orcid":"0009-0007-4942-5826","position":6,"is_corresponding":false},{"id":1089709,"name":"Joseph Yabes","orcid":"0000-0002-8119-5510","position":7,"is_corresponding":false},{"id":670634,"name":"Derek Larson","orcid":"0000-0002-6147-7182","position":8,"is_corresponding":false},{"id":237092,"name":"John H. 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