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Persistent low‐level viraemia and virological failure in HIV‐1‐infected patients treated with highly active antiretroviral therapy
Author(s) -
Sungkanuparph S,
Groger RK,
Overton ET,
Fraser VJ,
Powderly WG
Publication year - 2006
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/j.1468-1293.2006.00403.x
Subject(s) - medicine , viral load , hazard ratio , confidence interval , proportional hazards model , gastroenterology , retrospective cohort study , antiretroviral therapy , cohort , human immunodeficiency virus (hiv) , immunology
Objective To assess the prognostic significance of persistent low‐level viraemia (PLV, defined as persistent plasma viral loads of 51–1000 HIV‐1 RNA copies/mL for at least 3 months) in patients who had achieved viral suppression on antiretroviral therapy (ART). Methods A retrospective cohort of HIV‐infected patients who received ART, were followed‐up for ≥12 months, made regular visits to the clinic during which blood tests were performed for an ultrasensitive HIV RNA assay every 3 months, and achieved viral loads <50 copies/mL were evaluated. Virological failure was defined as two consecutive viral load measurements >1000 copies/mL. Results Of 362 patients, 78 (27.5%) experienced PLV. The demographics of patients with and without PLV were similar. PLV occurred at a mean (±standard deviation) of 22.6±16.9 months after ART initiation and lasted for 6.4±3.4 months. During a median follow‐up of 29.5 months, patients with PLV had a higher rate of virological failure (39.7% vs 9.2%; P <0.001). The median time to failure was 68.4 months [95% confidence interval (CI) 37.0–99.7] for patients with PLV and >72 months for patients without PLV (log rank test, P <0.001). By Cox regression, patients with PLV had a greater risk of virological failure [hazard ratio (HR) 3.8; 95% CI 2.2–6.4; P <0.001]. Among patients with PLV, a PLV of >400 copies/mL (HR 3.3; 95% CI 1.5–7.1; P =0.003) and a history of ART (HR 2.4; 95% CI 1.0–5.7; P =0.042) predicted virological failure. Conclusions PLV is associated with virological failure. Patients with a PLV >400 copies/mL and a history of ART experience are more likely to experience virological failure. Patients with PLV should be considered for treatment optimization and interventional studies.