BACKGROUND: Transient episodes of HIV type-1 viraemia are frequently observed in patients on suppressive combination antiretroviral therapy (cART). We studied the effect of such episodes and of treatment interruptions on clinical outcome and immunological response. METHODS: A total of 3,321 patients from the ATHENA cohort had virological suppression (HIV type-1 RNA<50 copies/ml) after 24 weeks of cART. The association between subsequent episodes of treatment interruptions, viral suppression, low-level (50-400 copies/ml) and high-level (>400 copies/ml) viraemia and the outcomes death, AIDS or immunological response (CD4(+) T-cell count increase > or =50% from 24 weeks) was studied with Poisson regression models, including either time-updated cumulative follow-up, time spent per type of episode or modelling episodes as binary status indicators. RESULTS: During 11,165 person-years of follow-up, 88 patients died, 111 developed AIDS and 2,019 had an immunological response. Longer follow-up time in treatment interruptions increased the risk of AIDS (relative risk [RR] 8.07, 95% confidence interval [CI] 3.98-16.4 per year longer) and impaired immunological response (RR 0.22, 95% CI 0.12-0.41). High-level viraemia was only associated with immunological response (RR 0.55, 95% CI 0.40-0.74), whereas low-level viraemia was not associated with any of the three outcomes. Status indicator models gave similar results. When also including time-updated CD4(+) T-cell counts, the observed associations diminished. CONCLUSIONS: Treatment interruptions and high-level, but not low-level, viraemia are strongly associated with clinical outcome, mainly via their effect on CD4(+) T-cell counts.
BACKGROUND: Transient episodes of HIV type-1 viraemia are frequently observed in patients on suppressive combination antiretroviral therapy (cART). We studied the effect of such episodes and of treatment interruptions on clinical outcome and immunological response. METHODS: A total of 3,321 patients from the ATHENA cohort had virological suppression (HIV type-1 RNA<50 copies/ml) after 24 weeks of cART. The association between subsequent episodes of treatment interruptions, viral suppression, low-level (50-400 copies/ml) and high-level (>400 copies/ml) viraemia and the outcomes death, AIDS or immunological response (CD4(+) T-cell count increase > or =50% from 24 weeks) was studied with Poisson regression models, including either time-updated cumulative follow-up, time spent per type of episode or modelling episodes as binary status indicators. RESULTS: During 11,165 person-years of follow-up, 88 patients died, 111 developed AIDS and 2,019 had an immunological response. Longer follow-up time in treatment interruptions increased the risk of AIDS (relative risk [RR] 8.07, 95% confidence interval [CI] 3.98-16.4 per year longer) and impaired immunological response (RR 0.22, 95% CI 0.12-0.41). High-level viraemia was only associated with immunological response (RR 0.55, 95% CI 0.40-0.74), whereas low-level viraemia was not associated with any of the three outcomes. Status indicator models gave similar results. When also including time-updated CD4(+) T-cell counts, the observed associations diminished. CONCLUSIONS: Treatment interruptions and high-level, but not low-level, viraemia are strongly associated with clinical outcome, mainly via their effect on CD4(+) T-cell counts.
Authors: Joseph B Sempa; Jonathan Dushoff; Michael J Daniels; Barbara Castelnuovo; Agnes N Kiragga; Martin Nieuwoudt; Steven E Bellan Journal: Am J Epidemiol Date: 2016-05-04 Impact factor: 4.897
Authors: Olof Elvstam; Gaetano Marrone; Patrik Medstrand; Carl Johan Treutiger; Anders Sönnerborg; Magnus Gisslén; Per Björkman Journal: Clin Infect Dis Date: 2021-06-15 Impact factor: 9.079
Authors: Abigail Eastburn; Rebecca Scherzer; Andrew R Zolopa; Constance Benson; Russell Tracy; Tri Do; Peter Bacchetti; Michael Shlipak; Carl Grunfeld; Phyllis C Tien Journal: PLoS One Date: 2011-11-02 Impact factor: 3.240
Authors: Joshua B Mendelsohn; Marian Schilperoord; Paul Spiegel; Susheela Balasundaram; Anuradha Radhakrishnan; Christopher K C Lee; Natasha Larke; Alison D Grant; Egbert Sondorp; David A Ross Journal: AIDS Behav Date: 2014-02