SCF TIER I — PREVENTATIVE (Terrain Stabilization)

Appendix Code: SCF-VIR-PRISM-APP-T1-001

SCF Tier Function: Preventative (P)

PCR Role: Terrain stabilization → immune noise reduction → downstream responsiveness

I. TIER I — FUNCTIONAL DEFINITION (SCF)

Tier I targets reversible, upstream vulnerabilities that predispose patients to immune drift, poor ART responsiveness, and reservoir persistence. These are host-system conditions, not viral replication mechanisms.

Tier I is mandatory prior to any Curative (C) or Restorative (R) engagement.

Key Biological Domains

• Redox imbalance (GSH depletion, ROS excess)
• Mitochondrial inefficiency
• Low-grade systemic inflammation
• Metabolic strain that amplifies immune noise

II. TIER I — FDA-APPROVED / PRE-APPROVED AGENTS

1) N‑Acetylcysteine (NAC)

Regulatory Status

• FDA-approved (Rx/OTC forms; indication-dependent)
• Extensive clinical safety record

Product Description

• Cysteine donor → glutathione (GSH) replenishment
• Potent intracellular antioxidant; mitochondrial protection
• Reduces ROS-driven inflammatory signaling

Primary Mechanism (Host-Directed)

• Restores redox buffering capacity
• Stabilizes mitochondrial membrane potential
• Dampens NF-κB–linked inflammatory noise

Role Within the SCF-PCR Braid

• PCR Phase: Preventative (P)
• Tier Function: Establishes metabolic and redox baseline required for accurate immune signaling
• Dependency Logic: Tier II immunomodulation is unstable without NAC-mediated redox correction

“1+1⇒3” Synergistic Augmentation

• NAC (Redox Reset) + ART (Viral Suppression)

⇒ Emergent effect: Reduced immune activation without immunosuppression

• Enables lower inflammatory set-point, improving downstream cytokine modulation efficiency

2) Metformin

Regulatory Status

• FDA-approved (Type 2 diabetes)
• Widely repurposed in metabolic-inflammatory contexts

Product Description

• AMPK activator; mitochondrial complex I modulation
• Improves insulin sensitivity and metabolic efficiency

Primary Mechanism (Host-Directed)

• Enhances cellular energy sensing
• Reduces mTOR overactivation linked to immune exhaustion
• Lowers lactate accumulation and metabolic stress

Role Within the SCF-PCR Braid

• PCR Phase: Preventative (P)
• Tier Function: Metabolic harmonizer preventing immune-metabolic crosstalk dysfunction
• Dependency Logic: Improves tolerance and response to later Tier II/III agents

“1+1⇒3” Synergistic Augmentation

• Metformin (Metabolic Efficiency) + NAC (Redox Stability)

⇒ Emergent effect: Coherent mitochondrial signaling → quieter immune baseline

• Converts energy stress from a pathology amplifier into a stability factor

3) Atorvastatin

Regulatory Status

• FDA-approved (hyperlipidemia, CV risk reduction)

Product Description

• HMG-CoA reductase inhibitor with pleiotropic anti-inflammatory effects
• Reduces CRP and endothelial inflammation independent of lipid lowering

Primary Mechanism (Host-Directed)

• Suppresses isoprenoid-mediated inflammatory signaling
• Improves endothelial and immune cell membrane stability

Role Within the SCF-PCR Braid

• PCR Phase: Preventative (P)
• Tier Function: Dampens vascular and immune activation that fuels chronic inflammation
• Dependency Logic: Prevents inflammatory rebound during Tier II cytokine modulation

“1+1⇒3” Synergistic Augmentation

• Atorvastatin (Inflammation Dampening) + Metformin (AMPK)

⇒ Emergent effect: Reduced immune-vascular crosstalk → improved tissue perfusion and immune trafficking

• Lowers baseline inflammatory “gain,” reducing downstream drug burden

III. TIER I — COMPOSITE SYNERGY LOGIC (SYSTEM-LEVEL)

SCF Role Assignment (Non-Additive)

SCF Principle Enforced:

Each agent has one job, no redundancy, no additive toxicity.

IV. WHY TIER I IS NOT OPTIONAL

Tier I does not treat HIV directly.

It treats the biological conditions that make HIV chronic.

V. SAFETY & GOVERNANCE (TIER I)

• Longstanding human safety data
• Pediatric-compatible with monitoring
• DSMB stop rules focus on unexpected immune suppression or mitochondrial toxicity
• Designed for short- to mid-term use, not indefinite therapy

VI. EXECUTIVE SUMMARY (TIER I)

Tier I of PRISM-ΔHIV uses FDA-approved, host-directed agents to:

1. Normalize redox and metabolic terrain
2. Reduce immune noise that confounds downstream therapy
3. Enable true synergy rather than additive polypharmacy

This tier converts ART from a lifelong suppressive necessity into a temporary virologic scaffold for systems-level repair.

SCF TIER II — PREVENTATIVE → EARLY CURATIVE

(Cytokine Load & Immune Drift Suppression)

Appendix Code: SCF-VIR-PRISM-APP-T2-001

SCF Tier Function: Preventative → Early Curative (P→C)

PCR Role: Cytokine normalization → immune signal fidelity → eligibility for structural repair (Tier III)

I. TIER II — FUNCTIONAL DEFINITION (SCF)

Tier II targets maladaptive immune signaling—persistent cytokine activation and exhaustion phenotypes that ART does not correct and that destabilize immune architecture if left untreated.

Tier II principles (non-negotiable):

• Time-limited (never chronic)
• Biomarker-gated
• Signal-level modulation, not immunosuppression
• Must follow Tier I redox/metabolic stabilization

Key Biological Domains

• IL-6 / IFN-γ / TNF-α overactivity
• JAK-STAT drift
• mTOR overactivation and immune exhaustion
• Inflammatory rebound risk during downstream repair

II. TIER II — FDA-APPROVED / PRE-APPROVED AGENTS

1) Tofacitinib

Regulatory Status

• FDA-approved (rheumatoid arthritis, psoriatic arthritis, UC)

Product Description

• Oral JAK1/3 inhibitor
• Rapid, reversible suppression of cytokine signal amplification

Primary Mechanism (Host-Directed)

• Dampens IL-6/IFN-γ signal propagation
• Reduces immune exhaustion pressure without depleting cells

Role Within the SCF-PCR Braid

• PCR Phase: Preventative → Early Curative (P→C)
• Tier Function: Interrupts cytokine-driven immune drift that blocks Tier III repair
• Dependency Logic: Requires Tier I redox/metabolic stability to avoid over-suppression

“1+1⇒3” Synergistic Augmentation

• Tofacitinib (Signal Dampening) + NAC/Metformin (Terrain Stability)

⇒ Emergent effect: Precise cytokine normalization without immune collapse

• Converts broad JAK inhibition into selective signal correction

2) Baricitinib

Regulatory Status

• FDA-approved (rheumatoid arthritis)
• Emergency-use experience in hyper-inflammatory states

Product Description

• JAK1/2 inhibitor with interferon-signal modulation
• Predictable PK; favorable short-course tolerability

Primary Mechanism (Host-Directed)

• Suppresses IFN-γ–dominant inflammatory loops
• Reduces immune overactivation linked to tissue injury

Role Within the SCF-PCR Braid

• PCR Phase: Preventative → Early Curative (P→C)
• Tier Function: Stabilizes immune signaling prior to stromal repair
• Dependency Logic: Used only in time-limited windows to prevent downstream fibrosis

“1+1⇒3” Synergistic Augmentation

• Baricitinib (IFN Modulation) + Atorvastatin (Inflammation Dampening)

⇒ Emergent effect: Reduced immune-vascular inflammatory crosstalk

• Lowers tissue-level injury risk during immune recalibration

3) Sirolimus

Regulatory Status

• FDA-approved (transplant immunosuppression)
• Extensive human exposure data

Product Description

• mTORC1 inhibitor; metabolic-immune signal regulator
• Dose-dependent effects ranging from immune suppression to immune reprogramming

Primary Mechanism (Host-Directed)

• Reduces mTOR overactivation linked to immune exhaustion
• Improves T-cell metabolic fitness and longevity at low exposure

Role Within the SCF-PCR Braid

• PCR Phase: Early Curative (C)
• Tier Function: Re-aligns immune metabolic signaling before structural repair
• Dependency Logic: Requires Tier I–II completion to avoid maladaptive suppression

“1+1⇒3” Synergistic Augmentation

• Sirolimus (mTOR Reset) + Metformin (AMPK)

⇒ Emergent effect: Balanced immune metabolism → improved tolerance of repair phases

• Converts an immunosuppressant into an immune longevity signal

III. TIER II — COMPOSITE SYNERGY LOGIC (SYSTEM-LEVEL)

SCF Role Assignment (Strict, Non-Additive)

SCF Enforcement Rule:

No Tier II agent is continued beyond its biomarker-defined window.

IV. WHY TIER II IS TIME-LIMITED (CRITICAL)

Tier II exists to quiet the signal, not silence the immune system.

V. SAFETY & GOVERNANCE (TIER II)

• Mandatory ANC and infection surveillance
• Pediatric growth and thymic output monitoring
• DSMB stop rules for:
• Grade ≥3 cytopenia
• Opportunistic infection signals
• Failure to normalize cytokines

Tier II failures trigger pause and reassessment, not escalation.

VI. EXECUTIVE SUMMARY (TIER II)

Tier II of PRISM-ΔHIV deploys FDA-approved immunomodulators in short, SCF-controlled windows to:

1. Correct immune signal drift
2. Prevent inflammatory damage during repair
3. Enable Tier III structural reconstruction

This tier transforms immunomodulation from a blunt suppressive tool into a precision signal corrector.

SCF TIER III — CURATIVE (ECM & Lymphoid Microenvironment Repair)

Appendix Code: SCF-VIR-PRISM-APP-T3-001

SCF Tier Function: Curative (Structural)

PCR Role: ECM normalization → lymphoid architecture restoration → prerequisite for epigenomic lineage repair (Tier IV)

I. TIER III — FUNCTIONAL DEFINITION (SCF)

Tier III addresses structural damage that sustains HIV persistence despite viral suppression, including:

• Lymph node and GALT fibrosis
• Stromal collapse impairing immune trafficking
• Aberrant angiogenic and fibroblast signaling

Tier III principles (non-negotiable):

• Structural, not virologic focus
• Time-bounded therapy with objective imaging/biomarker gates
• Must follow Tier I–II normalization to avoid maladaptive repair
• Mandatory before Tier IV (epigenomic lineage reconstitution)

Key Biological Domains

• TGF-β–driven fibrosis
• VEGF/FGF-mediated stromal dysregulation
• Impaired immune cell trafficking and niche support

II. TIER III — FDA-APPROVED / PRE-APPROVED AGENTS

1) Pirfenidone

Regulatory Status

• FDA-approved (idiopathic pulmonary fibrosis)

Product Description

• Oral antifibrotic with anti-TGF-β activity
• Reduces collagen synthesis and fibroblast activation

Primary Mechanism (Host-Directed)

• Suppresses fibrogenic signaling
• Promotes gradual ECM remodeling rather than abrupt degradation

Role Within the SCF-PCR Braid

• PCR Phase: Curative (C)
• Tier Function: Reverses lymphoid and GALT fibrosis that blocks immune trafficking
• Dependency Logic: Requires Tier II cytokine normalization to prevent inflammatory rebound

“1+1⇒3” Synergistic Augmentation

• Pirfenidone (Fibrosis Regression) + Baricitinib/Tofacitinib (Signal Quieting)

⇒ Emergent effect: Safe ECM remodeling without inflammatory flare

• Converts antifibrotic therapy into immune-permissive niche restoration

2) Nintedanib

Regulatory Status

• FDA-approved (idiopathic pulmonary fibrosis, systemic sclerosis-ILD)

Product Description

• Multi-kinase inhibitor (VEGFR, FGFR, PDGFR)
• Anti-angiogenic and anti-stromal proliferation effects

Primary Mechanism (Host-Directed)

• Limits pathological angiogenesis and fibroblast expansion
• Stabilizes stromal architecture during repair

Role Within the SCF-PCR Braid

• PCR Phase: Curative (C)
• Tier Function: Prevents aberrant vascular remodeling during ECM repair
• Dependency Logic: Used at low-intensity, time-limited exposure to avoid vascular compromise

“1+1⇒3” Synergistic Augmentation

• Nintedanib (Stromal Control) + Atorvastatin (Endothelial Stability)

⇒ Emergent effect: Controlled angiostasis with preserved perfusion

• Enables orderly lymphoid reconstruction rather than scar formation

3) Sargramostim

Regulatory Status

• FDA-approved (hematopoietic support)

Product Description

• Recombinant GM-CSF
• Enhances myeloid cell differentiation and tissue repair signaling

Primary Mechanism (Host-Directed)

• Promotes stromal–immune crosstalk
• Improves antigen presentation and immune cell trafficking

Role Within the SCF-PCR Braid

• PCR Phase: Curative → Early Restorative (C→R)
• Tier Function: Re-seeds functional immune niches after ECM normalization
• Dependency Logic: Administered after antifibrotic priming to avoid trapping cells in fibrotic matrices

“1+1⇒3” Synergistic Augmentation

• Sargramostim (Regenerative Signaling) + Pirfenidone/Nintedanib (Structural Reset)

⇒ Emergent effect: Functional niche regeneration with restored immune traffic

• Converts growth-factor support into architecture-aware regeneration

III. TIER III — COMPOSITE SYNERGY LOGIC (SYSTEM-LEVEL)

SCF Role Assignment (Strict, Non-Additive)

SCF Enforcement Rule:

Tier III agents are sequenced, not co-escalated; regeneration follows structural normalization.

IV. WHY TIER III IS MANDATORY BEFORE TIER IV

Tier III creates the physical context in which immune identity can be durably restored.

V. SAFETY & GOVERNANCE (TIER III)

• Imaging- and biomarker-gated continuation
• DSMB stop rules for:
• Worsening fibrosis or vascular compromise
• Discrepant tissue vs PBMC signals
• Pediatric considerations: growth-plate and perfusion monitoring where applicable

VI. EXECUTIVE SUMMARY (TIER III)

Tier III of PRISM-ΔHIV deploys FDA-approved antifibrotic and regenerative agents to:

1. Reverse lymphoid and GALT fibrosis
2. Restore immune trafficking and stromal support
3. Establish the structural prerequisite for epigenomic lineage repair

This tier transforms HIV from a virus in a damaged organ into a virus in a repaired immune system.

SCF TIER IV — CURATIVE → EARLY RESTORATIVE (Epigenomic Lineage Reconstitution)

Appendix Code: SCF-VIR-PRISM-APP-T4-001

SCF Tier Function: Curative → Early Restorative

PCR Role: Immune lineage identity restoration → durability of remission → prerequisite for ATI evaluation

I. TIER IV — FUNCTIONAL DEFINITION (SCF)

Tier IV targets epigenomic drift that locks immune cells into exhausted, dysfunctional phenotypes despite viral suppression and structural repair.

This tier does not debulk virus and does not perform oncologic cytotoxicity. It delivers signal-level epigenomic correction to restore immune lineage fidelity.

Tier IV principles (non-negotiable):

• Cycle-limited exposure with mandatory recovery
• Signal-level dosing only (non-oncologic)
• Requires Tier III completion (structural context first)
• Marrow recovery gates between cycles

Key Biological Domains

• DNA methylation drift (DNMT overactivity)
• Histone deacetylation–driven lineage silencing
• Loss of naïve T-cell output (TREC decline)
• Persistent exhaustion phenotypes (PD-1/TIM-3)

II. TIER IV — FDA-APPROVED / PRE-APPROVED AGENTS

1) Decitabine

Regulatory Status

• FDA-approved (myelodysplastic syndromes, AML)

Product Description

• Nucleoside analog DNMT inhibitor
• At low, intermittent exposure: epigenetic re-programmer rather than cytotoxic agent

Primary Mechanism (Host-Directed)

• Reduces pathological DNA hypermethylation
• Reactivates silenced immune lineage loci
• Improves naïve T-cell output when used below oncologic thresholds

Role Within the SCF-PCR Braid

• PCR Phase: Curative → Early Restorative (C→R)
• Tier Function: Unlocks immune identity programs suppressed by chronic inflammation and viral stress
• Dependency Logic: Requires Tier III ECM repair to ensure corrected cells populate functional niches

“1+1⇒3” Synergistic Augmentation

• Decitabine (Epigenetic Unlocking) + Pirfenidone/Nintedanib (Structural Normalization)

⇒ Emergent effect: Reprogrammed immune cells populate repaired lymphoid niches

• Converts hypomethylation from transient signal into durable lineage restoration

2) Azacitidine

Regulatory Status

• FDA-approved (MDS, AML)

Product Description

• DNMT inhibitor with RNA incorporation effects
• Predictable, reversible epigenomic modulation at low exposure

Primary Mechanism (Host-Directed)

• Restores transcriptional flexibility in immune progenitors
• Enhances immune renewal capacity

Role Within the SCF-PCR Braid

• PCR Phase: Curative → Early Restorative (C→R)
• Tier Function: Alternative or complementary DNMT modulation strategy
• Dependency Logic: Used in limited cycles only with marrow recovery confirmation

“1+1⇒3” Synergistic Augmentation

• Azacitidine (Lineage Re-opening) + Sargramostim (Niche Re-seeding)

⇒ Emergent effect: Newly reprogrammed cells differentiate into functional immune subsets

• Prevents re-locking of corrected epigenetic states

3) Romidepsin

Regulatory Status

• FDA-approved (cutaneous & peripheral T-cell lymphoma)

Product Description

• Potent HDAC inhibitor
• At carefully restricted exposure: chromatin accessibility modulator

Primary Mechanism (Host-Directed)

• Increases histone acetylation
• Restores accessibility to immune regulatory genes

Role Within the SCF-PCR Braid

• PCR Phase: Curative (restricted)
• Tier Function: Short-course chromatin reset for refractory exhaustion phenotypes
• Dependency Logic: Reserved for selected cases only after Tier III confirmation

“1+1⇒3” Synergistic Augmentation

• Romidepsin (Chromatin Opening) + Decitabine/Azacitidine (Methylation Reset)

⇒ Emergent effect: Coordinated chromatin + methylation correction without cytotoxic escalation

• Enables depth of reprogramming unattainable with either alone

III. TIER IV — COMPOSITE SYNERGY LOGIC (SYSTEM-LEVEL)

SCF Role Assignment (Strict, Non-Additive)

SCF Enforcement Rule:

No Tier IV agent proceeds without documented marrow recovery and Tier III structural readiness.

IV. WHY TIER IV IS ESSENTIAL FOR DURABLE REMISSION

Tier IV is the identity-restoring step that transforms viral control into self-maintained remission.

V. SAFETY & GOVERNANCE (TIER IV)

• Mandatory CBC monitoring with recovery gates
• DSMB stop rules for:
• Grade ≥3 cytopenia
• Failure to recover counts within predefined window
• Evidence of epigenomic instability
• Pediatric use: exception-only, specialist-reviewed, lowest effective exposure

VI. EXECUTIVE SUMMARY (TIER IV)

Tier IV of PRISM-ΔHIV deploys FDA-approved epigenomic agents in SCF-restricted, signal-level cycles to:

1. Restore immune lineage identity
2. Reduce exhaustion phenotypes
3. Enable safe, interpretable ATI testing
4. Support durable, ART-independent immune control

This tier converts immune correction from temporary activation into stable biological memory.

SCF TIER V — AIDS-CLASS (HIV-EXCLUSIVE) | ART + Regenerative PCR Braid & Remission Validation

Appendix Code: SCF-VIR-PRISM-APP-T5-001

SCF Tier Function: Viral Suppression + Remission Testing

PCR Role: Stabilize virology while host systems complete repair → enable ATI → validate immune autonomy

I. TIER V — FUNCTIONAL DEFINITION (SCF)

Tier V is not a stand-alone antiviral strategy.

It is the final braid layer that maintains virologic control only while Tier I–IV host-system repair completes and remission eligibility is tested.

Tier V principles (non-negotiable):

• ART is mandatory initially
• ART is not lifelong by default
• Host-directed repair (Tiers I–IV) determines durability
• ART de-escalation occurs only via protocolized ATI

Key Biological Domains

• Viral replication suppression
• Reservoir stabilization during repair
• Immune memory consolidation
• Safe, interpretable ART interruption

II. TIER V — FDA-APPROVED / PRE-APPROVED AGENTS

A. CORE ART BACKBONE (VIROLOGIC FLOOR)

1) Biktarvy

Regulatory Status

• FDA-approved single-tablet regimen

Product Description

• Integrase inhibitor (bictegravir) + dual NRTIs
• High barrier to resistance; favorable PK

Primary Mechanism (Virus-Directed)

• Blocks viral integration and replication
• Maintains undetectable plasma viremia

Role Within the SCF-PCR Braid

• PCR Phase: Curative scaffold (C)
• Tier Function: Virologic containment while host repair proceeds
• Dependency Logic: ART alone is insufficient without Tier III–IV repair

“1+1⇒3” Synergistic Augmentation

• Biktarvy (Viral Arrest) + Tier III/IV Host Repair

⇒ Emergent effect: Progressive reservoir contraction under immune normalization

• ART becomes a temporary stabilizer, not a lifelong crutch

2) Dolutegravir

Regulatory Status

• FDA-approved (multiple combinations)

Product Description

• Potent INSTI with high genetic barrier
• Flexible use across adult and pediatric populations

Primary Mechanism (Virus-Directed)

• Prevents proviral integration
• Suppresses residual replication during immune repair

Role Within the SCF-PCR Braid

• PCR Phase: Curative scaffold (C)
• Tier Function: Reinforces integration blockade during reservoir destabilization
• Dependency Logic: Maintained until ATI criteria met

“1+1⇒3” Synergistic Augmentation

• Dolutegravir (Integration Lock) + Epigenomic Lineage Repair (Tier IV)

⇒ Emergent effect: Reduced reseeding while immune identity is restored

3) Tenofovir alafenamide

Regulatory Status

• FDA-approved NRTI

Product Description

• Prodrug with enhanced intracellular delivery
• Lower systemic exposure vs earlier tenofovir forms

Primary Mechanism (Virus-Directed)

• Inhibits reverse transcription
• Reduces low-level replication noise

Role Within the SCF-PCR Braid

• PCR Phase: Curative scaffold (C)
• Tier Function: Intracellular suppression during immune recalibration
• Dependency Logic: Supports INSTI backbone during repair phases

“1+1⇒3” Synergistic Augmentation

• TAF (Intracellular Control) + Tier II Signal Normalization

⇒ Emergent effect: Lower immune activation while maintaining suppression

B. RESTORATIVE / IMMUNE CONSOLIDATION ADJUNCTS

4) CYT107 (IL-7)

Regulatory Status

• Investigational / late-stage clinical experience in HIV

Product Description

• Recombinant IL-7 promoting T-cell survival and expansion

Primary Mechanism (Host-Directed)

• Expands naïve and memory T-cell pools
• Enhances immune resilience post-repair

Role Within the SCF-PCR Braid

• PCR Phase: Restorative (R)
• Tier Function: Consolidates immune gains before ATI
• Dependency Logic: Used after Tier III–IV completion to avoid expanding exhausted clones

“1+1⇒3” Synergistic Augmentation

• IL-7 (Immune Expansion) + Tier IV Lineage Correction

⇒ Emergent effect: Durable, functional immune memory rather than bulk expansion

5) Maraviroc

Regulatory Status

• FDA-approved (CCR5-tropic HIV)

Product Description

• CCR5 antagonist with immunomodulatory properties

Primary Mechanism (Host-Directed + Virus-Directed)

• Blocks CCR5-mediated entry
• Modulates immune cell trafficking and inflammation

Role Within the SCF-PCR Braid

• PCR Phase: Curative → Restorative (C→R)
• Tier Function: Normalizes immune migration patterns during repair
• Dependency Logic: Useful during late Tier III–V transitions

“1+1⇒3” Synergistic Augmentation

• Maraviroc (Trafficking Modulation) + ECM Repair (Tier III)

⇒ Emergent effect: Correct immune homing into repaired lymphoid niches

III. TIER V — COMPOSITE SYNERGY LOGIC (SYSTEM-LEVEL)

SCF Role Assignment (Strict, Non-Additive)

SCF Enforcement Rule:

ART exposure is maintained only as long as biologically required to protect repair gains.

IV. WHY TIER V IS NOT “STANDARD ART”

Tier V reframes ART as a temporary virologic scaffold, not an endpoint.

V. SAFETY & GOVERNANCE (TIER V)

• ART safety per label
• ATI governed by DSMB-approved stop rules
• Immediate ART re-initiation triggers defined
• Pediatric cohorts require enhanced growth and developmental monitoring

VI. EXECUTIVE SUMMARY (TIER V)

Tier V of PRISM-ΔHIV integrates FDA-approved ART and immune-restorative adjuncts to:

1. Maintain virologic control during host repair
2. Consolidate immune recovery
3. Safely test ART independence via ATI
4. Distinguish suppression from true immune-mediated remission

This tier completes the SCF-PCR braid by converting viral control into validated immune autonomy.