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Factors associated with a strictly undetectable viral load in HIV ‐1‐infected patients
Author(s) -
MartinBlondel G,
Sauné K,
Vu Hai V,
Marchou B,
Delobel P,
Izopet J,
Cuzin L,
Massip P
Publication year - 2012
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.1468-1293.2012.01012.x
Subject(s) - medicine , viral load , confidence interval , odds ratio , regimen , gastroenterology , univariate analysis , prospective cohort study , immunology , human immunodeficiency virus (hiv) , multivariate analysis
Objectives The aim of the study was to identify factors associated with a strictly undetectable viral load ( VL ) using a routine sensitive real‐time polymerase chain reaction ( RT‐PCR ) technology. Methods From a large prospective cohort, 1392 patients with a VL < 50 HIV ‐1 RNA copies/ mL while receiving a three‐drug suppressive regimen for at least 1 year were included in a cross‐sectional analysis. Patients were classified into three groups and compared by univariate and multivariate analysis: 479 patients with a strictly undetectable VL (group 1; 34%), 617 patients with detectable VL below the threshold of 20 copies/ mL (group 2; 44%), and 296 patients with a VL of 20–50 copies/ mL (group 3; 12%). Results Comparing groups 1 and 2, VL zenith < 5 log 10 copies/ mL [odds ratio ( OR ) 1.51; 95% confidence interval ( CI ) 1.15–1.99; P = 0.003], current CD4 T ‐cell count < 500 cells/μ L ( OR 1.44; 95% CI 1.08–1.92; P = 0.01), and duration of viral suppression < 50 copies/ mL longer than 2 years ( OR 2.32; 95% CI 1.20–4.54; P = 0.01) were associated with undetectable VL . Comparing groups 1 and 3, VL zenith < 5 log 10 copies/ mL ( OR 2.48; 95% CI 1.75–3.50; P < 0.001), duration of viral suppression < 50 copies/ mL longer than 1 year ( OR 3.33; 95% CI 1.66–6.66; P = 0.0006), and nonnucleoside reverse transcriptase inhibitor ( NNRTI )‐based regimens ( OR 1.45; 95% CI 1.03–2.04; P = 0.03) were associated with undetectable VL . No individual drug effect was found within NNRTI molecules. Conclusions Longer duration of viral suppression < 50 copies/ mL , lower viral load zenith and NNRTI ‐based regimen were independently associated with a strictly undetectable viral load. This routinely used RT‐PCR assay may prove to be a valuable tool in further large‐scale studies.