Virological Outcome and Management of Persistent Low-Level Viraemia in HIV-1-Infected Patients: 11 Years of the Swiss HIV Cohort Study
- 1 February 2014
- journal article
- research article
- Published by SAGE Publications in Antiviral Therapy
- Vol. 20 (2), 165-175
- https://doi.org/10.3851/imp2815
Abstract
Background: Management of persistent low-level viraemia (pLLV) in patients on combined antiretroviral therapy (cART) with previously undetectable HIV viral loads (VLs) is challenging. We examined virological outcome and management among patients enrolled in the Swiss HIV Cohort Study (SHCS). Methods: In this retrospective study (2000–2011), pLLV was defined as a VL of 21–400 copies/ml on ≥ three consecutive plasma samples with ≥8 weeks between first and last analyses, in patients undetectable for ≥24 weeks on cART. Control patients had ≥ three consecutive undetectable VLs over ≥32 weeks. Virological failure (VF), analysed in the pLLV patient group, was defined as a VL>400 copies/ml. Results: Among 9,972 patients, 179 had pLLV and 5,389 were controls. Compared to controls, pLLV patients were more often on unboosted protease inhibitor (PI)-based (adjusted odds ratio [aOR; 95% CI] 3.2 [1.8, 5.9]) and nucleoside/nucleotide reverse transcriptase inhibitor (NRTI)-only combinations (aOR 2.1 [1.1, 4.2]) than on non-nucleoside reverse transcriptase inhibitor and boosted PI-based regimens. At 48 weeks, 102/155 pLLV patients (66%) still had pLLV, 19/155 (12%) developed VF and 34/155 (22%) had undetectable VLs. Predictors of VF were previous VF (aOR 35 [3.8, 315]), unboosted PI-based (aOR 12.8 [1.7, 96]) or NRTI-only combinations (aOR 115 [6.8, 1,952]), and VLs>200 during pLLV (aOR 3.7 [1.1, 12]). No VF occurred in patients with persistent very LLV (21-49 copies/ml; n=26). At 48 weeks, 29/39 patients (74%) who changed cART had undetectable VLs, compared with 19/74 (26%) without change ( P 200 copies/ml.Keywords
This publication has 35 references indexed in Scilit:
- Increased Risk of Virologic Rebound in Patients on Antiviral Therapy with a Detectable HIV Load <48 Copies/mLPLOS ONE, 2012
- Prevalence and Significance of HIV-1 Drug Resistance Mutations among Patients on Antiretroviral Therapy with Detectable Low-Level ViremiaAntimicrobial Agents and Chemotherapy, 2012
- Persistent low-level HIV-1 RNA between 20 and 50 copies/mL in antiretroviral-treated patients: associated factors and virological outcomeJournal of Antimicrobial Chemotherapy, 2012
- Impact of Low-Level-Viremia on HIV-1 Drug-Resistance Evolution among Antiretroviral Treated-PatientsPLOS ONE, 2012
- Antiretroviral Drug Resistance in HIV-1–Infected Patients Experiencing Persistent Low-Level Viremia During First-Line TherapyThe Journal of Infectious Diseases, 2011
- The Effect of Raltegravir Intensification on Low-level Residual Viremia in HIV-Infected Patients on Antiretroviral Therapy: A Randomized Controlled TrialPLoS Medicine, 2010
- Treatment Modification in Human Immunodeficiency Virus–Infected Individuals Starting Combination Antiretroviral Therapy Between 2005 and 2008JAMA Internal Medicine, 2010
- Treatment intensification does not reduce residual HIV-1 viremia in patients on highly active antiretroviral therapyProceedings of the National Academy of Sciences of the United States of America, 2009
- HIV rebounds from latently infected cells, rather than from continuing low-level replicationProceedings of the National Academy of Sciences of the United States of America, 2008
- Treatment for Adult HIV InfectionJAMA, 2004