Transient detectable viremia and the risk of viral rebound in patients from the Swiss HIV Cohort Study.

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State: Public
Version: Final published version
Serval ID
serval:BIB_6B6E34494A37
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Transient detectable viremia and the risk of viral rebound in patients from the Swiss HIV Cohort Study.
Journal
Bmc Infectious Diseases
Author(s)
Young J., Rickenbach M., Calmy A., Bernasconi E., Staehelin C., Schmid P., Cavassini M., Battegay M., Günthard H.F., Bucher H.C.
Working group(s)
Swiss HIV Cohort Study
ISSN
1471-2334 (Electronic)
ISSN-L
1471-2334
Publication state
Published
Issued date
2015
Peer-reviewed
Oui
Volume
15
Number
1
Pages
382
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Abstract
BACKGROUND: Temporary increases in plasma HIV RNA ('blips') are common in HIV patients on combination antiretroviral therapy (cART). Blips above 500 copies/mL have been associated with subsequent viral rebound. It is not clear if this relationship still holds when measurements are made using newer more sensitive assays.
METHODS: We selected antiretroviral-naive patients that then recorded one or more episodes of viral suppression on cART with HIV RNA measurements made using more sensitive assays (lower limit of detection below 50 copies/ml). We estimated the association in these episodes between blip magnitude and the time to viral rebound.
RESULTS: Four thousand ninety-four patients recorded a first episode of viral suppression on cART using more sensitive assays; 1672 patients recorded at least one subsequent suppression episode. Most suppression episodes (87 %) were recorded with TaqMan version 1 or 2 assays. Of the 2035 blips recorded, 84 %, 12 % and 4 % were of low (50-199 copies/mL), medium (200-499 copies/mL) and high (500-999 copies/mL) magnitude respectively. The risk of viral rebound increased as blip magnitude increased with hazard ratios of 1.20 (95 % CI 0.89-1.61), 1.42 (95 % CI 0.96-2.19) and 1.93 (95 % CI 1.24-3.01) for low, medium and high magnitude blips respectively; an increase of hazard ratio 1.09 (95 % CI 1.03 to 1.15) per 100 copies/mL of HIV RNA.
CONCLUSIONS: With the more sensitive assays now commonly used for monitoring patients, blips above 200 copies/mL are increasingly likely to lead to viral rebound and should prompt a discussion about adherence.
Keywords
Adult, Anti-HIV Agents/therapeutic use, Cohort Studies, Female, HIV Infections/diagnosis, HIV Infections/drug therapy, Humans, Male, Middle Aged, Proportional Hazards Models, RNA, Viral/blood, Risk, Viral Load, Viremia/diagnosis, Viremia/virology
Pubmed
Web of science
Open Access
Yes
Create date
06/10/2015 11:56
Last modification date
20/08/2019 15:25
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