Influencing factors and adverse outcomes of virologic rebound states in anti-retroviral-treated individuals with HIV infection

Yuan, Defu; Li, Mingma; Zhou, Ying; Shi, Lingen; Lu, Jing; Fu, Gengfeng; Wang, Bei

doi:10.1016/j.jve.2023.100320

Cited by 5 publications

(5 citation statements)

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“…Our study found associations between viral suppression prior to initial low-level viraemia and an increased likelihood of PLLV, and while this relationship has not been properly understood 62 other researchers have associated persistent viraemia with ongoing cycles of viral replication even in patients who have achieved viral suppression <50 copies/ml. 63 , 64 Replication can occur due to suboptimal drug penetration in anatomical reservoirs or the production of virions that do not infect new cells by clonally expanded infected T cells. 62 The association could also be related to similar factors in long ART duration, including treatment fatigue and declining adherence, which can be addressed with continued adherence monitoring and support for clients who have attained viral suppression.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and predictors of persistent low-level HIV viraemia: a retrospective cohort study among people receiving dolutegravir-based antiretroviral therapy in Southern Nigeria

Onwah,

Nwanja,

Akpan

et al. 2024

Therapeutic Advances in Infection

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Background: Persistent low-level viraemia (PLLV) is a risk factor for virologic failure among people receiving antiretroviral therapy (ART). Objectives: We assessed the prevalence and predictors of PLLV among individuals receiving Dolutegravir-based ART in southern Nigeria. Design: This retrospective cohort study used routine program data from electronic medical records of persons receiving Dolutegravir-based first-line ART in 154 PEPFAR/USAID-supported health facilities in Akwa Ibom and Cross Rivers states, Nigeria. Methods: Clients on first-line Dolutegravir-based ART ⩾6 months, who had a viral load result in the 12 months preceding October 2021 (baseline), and a second viral load result by September 2022 were included. Persons with low-level viraemia (LLV) (viral load 51–999 copies/ml) received additional adherence support. The outcome analysed was PLLV (two consecutive LLV results). Indices were summarized using descriptive statistics, and predictors of PLLV were determined using multivariate logistic regression. Results: In total, 141,208 persons on ART were included, of which 63.3% ( n = 89,944) were females. The median age was 36 [29–44] years, median ART duration was 19 [11–42] months. At the end of the study, 10.5% (14,759/141,208) had initial LLV, 90.1% (13,304/14,759) of which attained undetectable viral load (⩽50 copies/ml), and 1.1% (163/14,759) transitioned to virologic failure (⩾1000 copies/ml) by the end of the study. PLLV prevalence was 0.9% (1292/141,208). Increasing ART duration [adjusted odds ratio (aOR) = 1.0; 95% confidence interval (CI): 1.005–1.008; p < 0.001] and viral suppression (<1000 copies/ml) before initial LLV (aOR = 1.7; 95% CI: 1.50–2.00; p < 0.001) were positively associated with PLLV, while receipt of tuberculosis preventive therapy reduced the likelihood of PLLV (aOR = 0.3; 95% CI: 0.10–0.94; p = 0.039). Conclusion: PLLV was uncommon among individuals receiving dolutegravir-based ART and was associated with longer ART duration, prior viral suppression, and non-receipt of tuberculosis preventive therapy. This strengthens recommendations for continuous adherence support and comprehensive health services with ART, to prevent treatment failure.

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Section: Discussionmentioning

confidence: 99%

Prevalence and predictors of persistent low-level HIV viraemia: a retrospective cohort study among people receiving dolutegravir-based antiretroviral therapy in Southern Nigeria

Onwah,

Nwanja,

Akpan

et al. 2024

Therapeutic Advances in Infection

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“…The subtype composition was more complex in Yunnan, which borders Myanmar, Vietnam, and Laos, owing to frequent cross-border HIV transmission [ 23 ], and the new subtype numbers were significantly higher in Yunnan [ 24 ], explaining the difference in HIV-1 subtype composition from Jiangsu. Previous studies have shown that the antibodies produced after HIV infection are insufficient to resist re-infection with other HIV strains [ 25 ], and re-infection leads to many adverse outcomes due to the virologic rebound [ 26 ]. Movement of patients between cities, and especially across provinces, and failure to maintain optimal ART outcomes and reduce their high-risk behavior, may lead to recombination of different subtypes and new subtypes emerging [ 27 ], bringing more challenges to HIV prevention and control.…”

Section: Discussionmentioning

confidence: 99%

Prevention and Control Are Not a Regional Matter: A Spatial Correlation and Molecular Linkage Analysis Based on Newly Reported HIV/AIDS Patients in 2021 in Jiangsu, China

Yuan,

Liu,

Ouyang

et al. 2023

Viruses

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HIV-related spatial analysis studies in China are relatively few, and Jiangsu Province has not reported the relevant data in recent years. To describe the spatial distribution and molecular linkage characteristics of HIV-infected patients, this article combined descriptive epidemiology, spatial analysis, and molecular epidemiology methods to analyze patient reporting, patient mobility information, and HIV sequence information simultaneously. The results showed that HIV reporting profiles differed among Jiangsu cities, with the reporting rate in southern Jiangsu being above average. There was a spatial autocorrelation (Global Moran I = 0.5426, p < 0.05), with Chang Zhou showing a High–High aggregation pattern. Chang Zhou and Wu Xi were identified as hotspots for HIV reporting and access to molecular transmission networks. Some infected individuals still showed cross-city or even cross-province mobility after diagnosis, and three were linked with individuals in the destination cities within the largest molecular transmission cluster, involving 196 patients. The cross-city or cross-province mobility of patients may result in a potential HIV transmission risk, suggesting that combining timely social network surveys, building an extensive transmission network across cities and provinces, and taking critical regions and key populations as entry points could contribute to improved prevention and control efficiency and promote achievement of the 95-95-95 target and cascade.

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“…Low-level viremia and blip are two laboratory results which are important in predicting virologic failure in patients on ART. This is an object of debate because of contrasting results which have been published, possibly due to the heterogeneity of the study designs and to the involvement of unknown factors associated with the suboptimal control of viral replication [ 45 , 46 , 47 ]. Here, we discuss data from recent studies focusing on the influence of uncontrolled HIV viremia as blip (isolated plasma HIV RNA value < 1000 copies/mL with a return to undetectable levels) or as low-level viremia (plasma HIV RNA value 50–200 copies/mL) as defined by IAS-USA [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Predicting Factors of Plasma HIV RNA Undetectability after Switching to Co-Formulated Bictegravir, Emtricitabine, and Tenofovir Alafenamide in Experienced HIV-1 Patients: A Multicenter Study

Basso

Battagin

Nicolè

et al. 2023

Viruses

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Switching to bictegravir, emtricitabine, and tenofovir alafenamide (BIC/FTC/TAF) from other antiretroviral regimens is safe and effective for virologically suppressed people living with HIV (PLWH). The term virological suppression includes both low but detectable HIV viremia and undetectable HIV viremia, and the latter is possibly associated with a lower immune activation state. Herein, we describe a 24-month follow-up of experienced PLWH with plasma HIV RNA undetectable or detectable < 50 copies/ml switching to BIC/FTC/TAF. A previous 12-month monitoring was available, and the factors correlated with treatment efficacy. This retrospective multicenter study included PLWH who switched to BIC/FTC/TAF in the period of 2019–2022, and who were HBsAg and HCV RNA negative. The follow-up study times were 6 (T6), 12 (T12), 18 (T18), and 24 (T24) months after the switch (T0). Survival analysis with multiple-failure-per-subject design, Kaplan–Meier survival estimates, multivariate analysis of variance, multilevel linear regression, and a hierarchical ordered logistic model were applied. A total of 329 PLWH had plasma HIV RNA which was either undetectable or detectable at <50 copies/mL at T0, and 197 responded to all inclusion criteria: M/F 140/57; the median CD4+ cell count was 677 cells/mm3; and HIV RNA at T0 was undetectable in 108 patients. Most of the 197 patients (122, 61.9%) were on a previous INSTI-based regimen. HIV RNA undetectability was more frequent at each follow-up point in patients with HIV RNA that was undetectable at T0, and it showed a higher frequency throughout the follow-up period in patients with always-undetectable HIV RNA in the 12 months before the switch. A higher nadir CD4 cell count had a predictive role, and HBcAb positivity had no influence. In conclusion, the switch could be programmed and possibly delayed on a case-by-case basis in order to achieve persistent plasma HIV RNA undetectability. Undiagnosed loss of HBcAb has no detrimental consequences on the response to BIC/FTC/TAF.

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Influencing factors and adverse outcomes of virologic rebound states in anti-retroviral-treated individuals with HIV infection

Cited by 5 publications

References 100 publications

Prevalence and predictors of persistent low-level HIV viraemia: a retrospective cohort study among people receiving dolutegravir-based antiretroviral therapy in Southern Nigeria

Prevalence and predictors of persistent low-level HIV viraemia: a retrospective cohort study among people receiving dolutegravir-based antiretroviral therapy in Southern Nigeria

Prevention and Control Are Not a Regional Matter: A Spatial Correlation and Molecular Linkage Analysis Based on Newly Reported HIV/AIDS Patients in 2021 in Jiangsu, China

Predicting Factors of Plasma HIV RNA Undetectability after Switching to Co-Formulated Bictegravir, Emtricitabine, and Tenofovir Alafenamide in Experienced HIV-1 Patients: A Multicenter Study

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