Eugenia Quiros-Roldan1, Elena Raffetti2, Francesco Castelli1, Emanuele Focà1, Filippo Castelnuovo3, Massimo Di Pietro4, Roberta Gagliardini5, Andrea Gori6, Annalisa Saracino7, Chiara Fornabaio8, Laura Sighinolfi9, Elisa Di Filippo10, Franco Maggiolo10, Francesco Donato11. 1. University Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Italy. 2. Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy elena.raffetti@gmail.com. 3. Hospital Division of Infectious and Tropical Diseases, Brescia Spedali Civili General Hospital, Brescia, Italy. 4. Clinical Infectious Diseases of 'Azienda Ospedaliera S. M. Annunziata' of Firenze, Italy. 5. Institute of Clinical Infectious Diseases of Catholic University of Rome, Italy. 6. Clinic of Infectious Diseases, San Gerardo de' Tintori Hospital, Monza, Italy. 7. Clinic of Infectious Diseases, University of Bari, Bari, Italy. 8. Clinical Infectious Diseases of 'Istituti Ospitalieri' of Cremona, Italy. 9. Clinical Infectious Diseases of 'Azienda Ospedaliera S. Anna' of Ferrara, Italy. 10. Clinical Infectious Diseases of 'Ospedale Papa Giovanni XXIII' of Bergamo, Italy. 11. Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy.
Abstract
OBJECTIVES: We investigated the association between persistent low-level viraemia, measured as viraemia copy-years (VCY), and all-cause mortality. METHODS: We included 3271 HIV-infected patients who initiated their first combined ART (cART) during 1998-2012 enrolled in the multicentre Italian MASTER cohort. VCY was defined as the area under the curve of plasma viral load (pVL) and expressed in log10 copies · years/mL. VCY was evaluated from cART initiation until the end of follow-up [VCY-overall (VCY-o)], and stratified into before [VCY-early (VCY-e)] and after [VCY-late (VCY-l)] the eighth month from starting cART, and as the ratio of VCY-l to follow-up duration (VCY-l/FUD). RESULTS: The risk of death increased of about 40% for higher than the median levels of VCY-o and VCY-e. Compared with subjects with permanently suppressed pVL after the eighth month from starting cART, mortality increased by 70% for those with VCY-l ≥3 log10 copies·years/mL, and by about 20-fold for those with VCY-l/FUD ≥2.3 log10 copies/mL. Patients who maintained low levels of VCY-l (<3 log10 copies · years/mL) or VCY-l/FUD (<2.3 log10 copies/mL) had a risk of death similar to patients with permanently suppressed pVL. CD4 cell count at baseline was predictive of high risk of death only in subjects with VCY-l ≥3 log10 copies · years/mL. CONCLUSIONS: The risk of death did not increase in HIV-infected patients with low levels of VCY-l compared with patients with permanent virological suppression.
OBJECTIVES: We investigated the association between persistent low-level viraemia, measured as viraemia copy-years (VCY), and all-cause mortality. METHODS: We included 3271 HIV-infectedpatients who initiated their first combined ART (cART) during 1998-2012 enrolled in the multicentre Italian MASTER cohort. VCY was defined as the area under the curve of plasma viral load (pVL) and expressed in log10 copies · years/mL. VCY was evaluated from cART initiation until the end of follow-up [VCY-overall (VCY-o)], and stratified into before [VCY-early (VCY-e)] and after [VCY-late (VCY-l)] the eighth month from starting cART, and as the ratio of VCY-l to follow-up duration (VCY-l/FUD). RESULTS: The risk of death increased of about 40% for higher than the median levels of VCY-o and VCY-e. Compared with subjects with permanently suppressed pVL after the eighth month from starting cART, mortality increased by 70% for those with VCY-l ≥3 log10 copies·years/mL, and by about 20-fold for those with VCY-l/FUD ≥2.3 log10 copies/mL. Patients who maintained low levels of VCY-l (<3 log10 copies · years/mL) or VCY-l/FUD (<2.3 log10 copies/mL) had a risk of death similar to patients with permanently suppressed pVL. CD4 cell count at baseline was predictive of high risk of death only in subjects with VCY-l ≥3 log10 copies · years/mL. CONCLUSIONS: The risk of death did not increase in HIV-infectedpatients with low levels of VCY-l compared with patients with permanent virological suppression.
Authors: Yunan Xu; Xinguang Chen; Akemi Wijayabahu; Zhi Zhou; Bin Yu; Emma C Spencer; Robert L Cook Journal: Curr HIV Res Date: 2020 Impact factor: 1.581
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