Giordano Madeddu1, Andrea De Vito1, Alessandro Cozzi-Lepri2, Antonella Cingolani3, Franco Maggiolo4, Carlo Federico Perno5, Roberta Gagliardini6, Giulia Marchetti7, Annalisa Saracino8, Antonella d'Arminio Monforte7, Andrea Antinori6, Enrico Girardi9. 1. Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy. 2. Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME) Institute for Global Health UCL, London, UK. 3. Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome. 4. Division of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo. 5. Department of Laboratory Medicine, Unit of Microbiology and Immunology, IRCCS Children Hospital Bambino Gesù. 6. HIV/AIDS Clinical Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome. 7. ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Clinic of Infectious and Tropical Diseases, Milan. 8. Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari. 9. Clinical Epidemiology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy.
Abstract
OBJECTIVE: Zero risk of linked HIV transmission in serodiscordant couples when the HIV-infected partner had viral load less than 200 copies/ml ('U status') was found in observational studies. We aimed at estimating the proportion of time in which 'U status' was maintained and identifying factors associated with the risk of losing it. DESIGN: Observational cohort study. METHODS: We included participants in the ICONA cohort who had reached an established 'U status' (viral load ≤200 copies/ml for >6 months) as of December 2010. The outcome was the number of person-days of follow-up (PDFU) above a viral load greater than 200 copies/ml, relative to the total number of PDFU observed. A logistic regression model was used to identify factors independently associated with the risk of losing 'U status'. RESULTS: Eight thousand, two hundred and forty-one persons living with HIV were included in the analysis who contributed 2 670 888 PDFU. Of these, 1648 (20%) were women, 768 (9%) were people who inject drugs (PWID), and 2066 (25%) were foreign-born. The median of viral load measurements was 9 (IQR: 4-15). Overall, only 3.1% of PDFU were observed when viral load was above 200 copies/ml. The proportion of PDFU with viral load more than 200 copies/ml was higher than average in women (5.3%), unemployed (5.4%), PWID (4.7%), and in people with more than three previous virologic failures (6.3%). These variables were significant predictors of losing 'U status' in the multivariable logistic regression. CONCLUSION: Our results reinforce the validity of the U=U message in real-world setting. However, we identified subsets of our study population at higher risk of losing the 'U status' for whom additional efforts are needed.
OBJECTIVE: Zero risk of linked HIV transmission in serodiscordant couples when the HIV-infected partner had viral load less than 200 copies/ml ('U status') was found in observational studies. We aimed at estimating the proportion of time in which 'U status' was maintained and identifying factors associated with the risk of losing it. DESIGN: Observational cohort study. METHODS: We included participants in the ICONA cohort who had reached an established 'U status' (viral load ≤200 copies/ml for >6 months) as of December 2010. The outcome was the number of person-days of follow-up (PDFU) above a viral load greater than 200 copies/ml, relative to the total number of PDFU observed. A logistic regression model was used to identify factors independently associated with the risk of losing 'U status'. RESULTS: Eight thousand, two hundred and forty-one persons living with HIV were included in the analysis who contributed 2 670 888 PDFU. Of these, 1648 (20%) were women, 768 (9%) were people who inject drugs (PWID), and 2066 (25%) were foreign-born. The median of viral load measurements was 9 (IQR: 4-15). Overall, only 3.1% of PDFU were observed when viral load was above 200 copies/ml. The proportion of PDFU with viral load more than 200 copies/ml was higher than average in women (5.3%), unemployed (5.4%), PWID (4.7%), and in people with more than three previous virologic failures (6.3%). These variables were significant predictors of losing 'U status' in the multivariable logistic regression. CONCLUSION: Our results reinforce the validity of the U=U message in real-world setting. However, we identified subsets of our study population at higher risk of losing the 'U status' for whom additional efforts are needed.
Authors: Andrea De Vito; Annarita Botta; Marco Berruti; Valeria Castelli; Vincenzo Lai; Chiara Cassol; Alessandro Lanari; Giulia Stella; Adrian Shallvari; Antonia Bezenchek; Antonio Di Biagio Journal: J Pers Med Date: 2022-01-31
Authors: Andrea De Vito; Agnese Colpani; Beatrice Zauli; Maria Chiara Meloni; Marco Fois; Vito Fiore; Giovanni Antonio Pintus; Vincenzo Gesualdo Nardi; Sergio Babudieri; Giordano Madeddu Journal: Healthcare (Basel) Date: 2022-06-08