Very low level viraemia and risk of virological failure in treated HIV-1-infected patients
Por:
Teira R, Vidal F, Muñoz-Sánchez P, Geijo P, Viciana P, Ribera E, Domingo P, Castaño M, Martínez E, Roca B, Puig T, Estrada V, Deig E, Galindo MJ, de la Fuente B, Lozano F, Montero M, Muñoz-Sanz A, Sanchez T, Terrón A, Romero-Palacios A, Lacalle JR, Garrido M and Suárez-Lozano I
Publicada:
1 mar 2017
Ahead of Print:
1 ago 2016
Resumen:
Objectives
The aim of the study was to investigate whether very low level viraemia (VLLV) (20-50 HIV-1 RNA copies/mL) was associated with increased risk of virological failure (VF) as compared with persistent full suppression (< 20 copies/mL).
Methods
From the VACH Cohort database, we selected those patients who started antiretroviral therapy (ART) after January 1997 and who achieved effective viral suppression [two consecutive viral loads (VLs) < 50 copies/mL] followed by full suppression (at least one VL < 20 copies/mL). We carried out survival analyses to investigate whether the occurrence of VLLV rather than maintaining full suppression at < 20 copies/mL was associated with virological failure (two consecutive VLs > 200 copies/mL or one VL > 200 copies/mL followed by a change of ART regimen, administrative censoring or loss to follow-up), adjusted for nadir CD4 cell count, sex, age, ethnicity, transmission group, type of ART and time on effective suppression at < 50 copies/mL.
Results
Of 21 480 patients who started ART, 13 674 (63.7%) achieved effective suppression at < 50 copies/mL, of whom 4289 (31.4%) further achieved full suppression at < 20 copies/mL after May 2009. A total of 2623 patients (61.1%) remained fully suppressed thereafter, while 1666 had one or more episodes of VL detection > 20 copies/mL (excluding virological failure). A total of 824 patients had VLLV after suppression at < 20 copies/mL. VLLV was not associated with virological failure as compared with persistent full suppression [hazard ratio (HR) 0.67; 95% confidence interval (CI) 0.44-1.00], independently of the number of blips recorded (from one to 18).
Conclusions
In our population of HIV-infected patients on ART who achieved viral suppression at < 20 copies/mL, the risk of virological failure was no different for patients who remained fully suppressed compared with those who experienced subsequent episodes of VLLV.
Filiaciones:
Teira R:
Sierrallana Hospital, Torrelavega, Spain
Vidal F:
Tarragona University Hospital Joan XXIII, Tarragona, Spain
Muñoz-Sánchez P:
Basurto Hospital, Bilbao, Spain
Geijo P:
Virgen de la Luz Hospital, Cuenca, Spain
Viciana P:
Virgen del Rocío Hospital, Sevilla, Spain
Ribera E:
Vall d'Hebrón Hospital, Barcelona, Spain
Domingo P:
Santa Creu i Sant Pau Hospital, Barcelona, Spain
Castaño M:
Carlos Haya Hospital, Málaga, Spain
Martínez E:
Albacete Hospital, Albacete, Spain
:
General Hospital, Castellón, Spain
Puig T:
Arnau de Vilanova Hospital, Lleida, Spain
Estrada V:
San Carlos Clinical Hospital, Madrid, Spain
Deig E:
General Hospital, Granollers, Spain
Galindo MJ:
Clinical Hospital, Valencia, Spain
de la Fuente B:
Cabueñes Hospital, Gijón, Spain
Lozano F:
Valme Hospital, Sevilla, Spain
Montero M:
La Fé Hospital, Valencia, Spain
Muñoz-Sanz A:
Infanta Cristina Hospital, Badajoz, Spain
Sanchez T:
Virgen de Rosell Hospital, Cartagena, Spain
Terrón A:
SAS Hospital, Jérez de la Frontera, Spain
Romero-Palacios A:
Clinical Hospital, Puerto Real, Spain
Lacalle JR:
Seville University, Sevilla, Spain
Garrido M:
VACH Medical Association, Cartaya, Spain
Suárez-Lozano I:
Infanta Elena Hospital, Huelva, Spain
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