Any impact of blips and low-level viraemia episodes among HIV-infected patients with sustained virological suppression on ART?

March 27, 2016 at 3:24 pm

Journal of Antimicrobial Chemotherapy April 2016 V.71 N.4 P.1051-1055

Editor’s Choice

Berta Pernas, Marta Grandal, Sonia Pertega, Angelina Cañizares, Ángeles Castro-Iglesias, Álvaro Mena, Iria Rodriguez-Osorio, Andrés Tabernilla, José D. Pedreira, and Eva Poveda

1Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, A Coruña, Spain

2Unidad de Epidemiología Clínica y Bioestadística, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, A Coruña, Spain

3Servicio de Microbiología, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, A Coruña, Spain

Objectives

The objective of this study was to evaluate the prevalence of blips and risk of virological failure (VF) among HIV-infected patients with sustained virological suppression (HIV-RNA <50 copies/mL) on ART.

Methods

Newly diagnosed (2004–13) HIV-infected patients with sustained virological suppression on ART (minimum follow-up of 3 months) were identified. Risk of VF was evaluated according to different plasma HIV-RNA quantification values based on the limits of quantification/detection of current commercial assays (20 copies/mL). Kaplan–Meier and Cox proportional hazards models were used to compare the cumulative incidence of VF.

Results

A total of 565 newly diagnosed HIV-infected patients were identified: 453 started ART and 354 achieved virological suppression. Prevalence of blips (isolated HIV-RNA ranging from 50 to 200 copies/mL) and VF (HIV-RNA ≥50 copies/mL) was 22.7% and 8.8%, respectively (mean follow-up of 42 months). Multivariate analysis identified differences between HIV-RNA values as an independent predictor of VF (P=0.008); risk of VF was higher for patients with blips [HR 2.500 (95% CI 0.524–11.926)] and for those with at least three consecutive detected, but not quantified, HIV-RNA determinations (HIV-RNA <20 copies/mL) [HR 3.813 (95% CI 0.675–21.535)]. Moreover, only HIV-infected patients with at least three consecutive detected, but not quantified, HIV-RNA determinations showed a higher probability of virological rebound with >200 copies/mL [33.7% at 24 and 60 months versus <5% for other HIV-RNA values; HR 6.943 (0.728–66.261), P=0.092].

Conclusions

Blips are frequent (22.7%) among HIV-infected patients with sustained virological suppression on ART. HIV patients with blips and at least three consecutive detected, but not quantified, HIV-RNA determinations (<20 copies/mL) had a higher risk of VF. These findings highlight the relevance of maintaining HIV-RNA levels below the limits of quantification of current assays (<20 copies/mL).

PDF

http://jac.oxfordjournals.org/content/71/4/1051.full.pdf

Entry filed under: Antirretrovirales, Biología Molecular, HIV/SIDA, HIV/SIDA HAART, HIV/SIDA Laboratorio, Infecciones virales, Metodos diagnosticos. Tags: .

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