R Teira1, F Vidal2, P Muñoz-Sánchez3, P Geijo4, P Viciana5, E Ribera6, P Domingo7, M Castaño8, E Martínez9, B Roca10, T Puig11, V Estrada12, E Deig13, M J Galindo14, B de la Fuente15, F Lozano16, M Montero17, A Muñoz-Sanz18, T Sanchez19, A Terrón20, A Romero-Palacios21, J R Lacalle22, M Garrido23, I Suárez-Lozano24. 1. Sierrallana Hospital, Torrelavega, Spain. 2. Tarragona University Hospital Joan XXIII, Tarragona, Spain. 3. Basurto Hospital, Bilbao, Spain. 4. Virgen de la Luz Hospital, Cuenca, Spain. 5. Virgen del Rocío Hospital, Sevilla, Spain. 6. Vall d'Hebrón Hospital, Barcelona, Spain. 7. Santa Creu i Sant Pau Hospital, Barcelona, Spain. 8. Carlos Haya Hospital, Málaga, Spain. 9. Albacete Hospital, Albacete, Spain. 10. General Hospital, Castellón, Spain. 11. Arnau de Vilanova Hospital, Lleida, Spain. 12. San Carlos Clinical Hospital, Madrid, Spain. 13. General Hospital, Granollers, Spain. 14. Clinical Hospital, Valencia, Spain. 15. Cabueñes Hospital, Gijón, Spain. 16. Valme Hospital, Sevilla, Spain. 17. La Fé Hospital, Valencia, Spain. 18. Infanta Cristina Hospital, Badajoz, Spain. 19. Virgen de Rosell Hospital, Cartagena, Spain. 20. SAS Hospital, Jérez de la Frontera, Spain. 21. Clinical Hospital, Puerto Real, Spain. 22. Seville University, Sevilla, Spain. 23. VACH Medical Association, Cartaya, Spain. 24. Infanta Elena Hospital, Huelva, Spain.
Abstract
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.
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-infectedpatients 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.
Authors: H Melliez; A Duhamel; O Robineau; L Bocket; I Kim; E Sauser; F Loiseleur; N Viget; A Pasquet; E Senneville; D Seguy Journal: Eur J Clin Microbiol Infect Dis Date: 2017-06-24 Impact factor: 3.267
Authors: Françoise Barré-Sinoussi; Salim S Abdool Karim; Jan Albert; Linda-Gail Bekker; Chris Beyrer; Pedro Cahn; Alexandra Calmy; Beatriz Grinsztejn; Andrew Grulich; Adeeba Kamarulzaman; Nagalingeswaran Kumarasamy; Mona R Loutfy; Kamal M El Filali; Souleymane Mboup; Julio Sg Montaner; Paula Munderi; Vadim Pokrovsky; Anne-Mieke Vandamme; Benjamin Young; Peter Godfrey-Faussett Journal: J Int AIDS Soc Date: 2018-07 Impact factor: 5.396