Lise Cuzin1, Pascal Pugliese, Karine Sauné, Clotilde Allavena, Jade Ghosn, Jacqueline Cottalorda, Audrey Rodallec, Marie Laure Chaix, Samira Fafi-Kremer, Cathia Soulié, Marlène Ouka, Charlotte Charpentier, Laurence Bocket, Audrey Mirand, Marguerite Guiguet. 1. aRegional Center for HIV Care and Coordination, INSERM UMR1027, Toulouse 3 University, Toulouse bInfectious Diseases Dpt, CHU Archet, Nice cINSERM, U1043, Centre de Physiopathologie de Toulouse Purpan dCHU Toulouse, Hôpital Purpan, Virology Department, National Reference Center for Hepatitis E, Institut fédératif de biologie de Purpan, Toulouse eInfectious Diseases Department, CHU Hotel Dieu, Nantes fAPHP, Department of Therapeutics in Infectious Diseases, Hotel Dieu Hospital gParis Descartes University, EA 7327, Sorbonne Paris Cité, Paris hVirology Department, CHU Nice, Nice iVirology Department, CHU Nantes, Nantes jVirology Department, AP-HP, Hôpital Saint Louis, INSERM U941, Paris Diderot University, Paris kVirology Department, CHU Strasbourg, Strasbourg lSorbonne University, UPMC Univ. Paris 06-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health mINSERM-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health nAP-HP, Groupe hospitalier Pitié Salpêtrière, Laboratoire de Virologie, Paris oVirology laboratory, University Hospital of Martinique, Fort-de-France pINSERM, IAME, UMR 1137 qUniv Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité rAP-HP, Hôpital Bichat-Claude Bernard, Virology Department, Paris sVirology Department, CHU Lille, Lille tCHU Clermont Ferrand, Laboratoire de Virologie, Hôpital Gabriel Montpied, Clermont-Ferrand uSorbonne Universities, UPMC Univ. Paris 06, INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France. *Dat'AIDS Study Group members are listed in the Acknowledgements.
Abstract
OBJECTIVE: The objective of this study is to study factors associated with HIV-DNA levels in chronically infected patients on long-term suppressive antiretroviral therapy (ART). DESIGN: A cross-sectional, multicentre study of patients receiving ART for more than 3 years, HIV-RNA less than 50 copies/ml for more than 2 years and CD4 cell count more than 350 cells/μl. METHOD: Factors associated with low (<150) or high (>1000), compared with intermediate (150-1000 copies/10 PBMCs) levels of HIV-DNA were investigated using multinomial logistic regression. RESULTS: Five hundred and twenty-two patients who initiated ART during the chronic phase were included (71% male; median peak HIV-RNA: 4.88 log10 copies/ml, CD4 cell count nadir: 222 cells/μl). Median ART duration was 13 years [interquartile range (IQR) 7-17], viral suppression was 5.7 years (IQR 3.9-8.5) and 66% of the patients never experienced ART failure. Median HIV-DNA was 323 copies/10 PBMCs (IQR, 129-717) with low, intermediate and high levels observed in 28.3, 55.4 and 16.3%, respectively. In multivariable analysis, women were more likely to achieve a low level of HIV-DNA. Each additional year with suppressed HIV-RNA increased the likelihood of low level and decreased the likelihood of high level of HIV-DNA. Peak HIV-RNA higher than 5log10 was always associated with a decreased risk of low and an increased risk of high HIV-DNA. For patients with peak HIV-RNA lower than 5log10, past ART failure was associated with high level of HIV-DNA. CONCLUSION: Chronically HIV-infected patients with long-term suppressive ART can achieve low total HIV-DNA but one over six still presented HIV-DNA above 1000 copies/10 PBMCs despite long-term viral suppression.
OBJECTIVE: The objective of this study is to study factors associated with HIV-DNA levels in chronically infectedpatients on long-term suppressive antiretroviral therapy (ART). DESIGN: A cross-sectional, multicentre study of patients receiving ART for more than 3 years, HIV-RNA less than 50 copies/ml for more than 2 years and CD4 cell count more than 350 cells/μl. METHOD: Factors associated with low (<150) or high (>1000), compared with intermediate (150-1000 copies/10 PBMCs) levels of HIV-DNA were investigated using multinomial logistic regression. RESULTS: Five hundred and twenty-two patients who initiated ART during the chronic phase were included (71% male; median peak HIV-RNA: 4.88 log10 copies/ml, CD4 cell count nadir: 222 cells/μl). Median ART duration was 13 years [interquartile range (IQR) 7-17], viral suppression was 5.7 years (IQR 3.9-8.5) and 66% of the patients never experienced ART failure. Median HIV-DNA was 323 copies/10 PBMCs (IQR, 129-717) with low, intermediate and high levels observed in 28.3, 55.4 and 16.3%, respectively. In multivariable analysis, women were more likely to achieve a low level of HIV-DNA. Each additional year with suppressed HIV-RNA increased the likelihood of low level and decreased the likelihood of high level of HIV-DNA. Peak HIV-RNA higher than 5log10 was always associated with a decreased risk of low and an increased risk of high HIV-DNA. For patients with peak HIV-RNA lower than 5log10, past ART failure was associated with high level of HIV-DNA. CONCLUSION: Chronically HIV-infectedpatients with long-term suppressive ART can achieve low total HIV-DNA but one over six still presented HIV-DNA above 1000 copies/10 PBMCs despite long-term viral suppression.
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