Predictors of viral suppression and rebound among HIV-positive men who have sex with men in a large multi-site Canadian cohort

Abstract

BackgroundGay, bisexual and other men who have sex with men (MSM) are disproportionately affected by HIV in Canada. Combination antiretroviral therapy has been shown to dramatically decrease progression to AIDS, premature death and HIV transmission. However, there are no comprehensive data regarding combination antiretroviral therapy outcomes among this population. We sought to identify socio-demographic and clinical correlates of viral suppression and rebound.MethodsOur analysis included MSM participants in the Canadian Observational Cohort, a multi-site cohort of HIV-positive adults from Canada’s three most populous provinces, aged ≥18 years who first initiated combination antiretroviral therapy between 2000 and 2011. We used accelerated failure time models to identify factors predicting time to suppression (2 measures <50 copies/mL ≥30 days apart) and subsequent rebound (2 measures >200 copies/mL ≥30 days apart).ResultsOf 2,858 participants, 2,448 (86 %) achieved viral suppression in a median time of 5 months (Q1–Q3: 3–7 months). Viral suppression was significantly associated with later calendar year of antiretroviral therapy initiation, no history of injection drug use, lower baseline viral load, being on an initial regimen consisting of non-nucleoside reverse-transcriptase inhibitors, and older age. Among those who suppressed, 295 (12 %) experienced viral rebound. This was associated with earlier calendar year of antiretroviral therapy initiation, injection drug use history, younger age, higher baseline CD4 cell count, and living in British Columbia.ConclusionsFurther strategies are required to optimize combination antiretroviral therapy outcomes in men who have sex with men in Canada, specifically targeting younger MSM and those with a history of injection drug use.

Long-term durability of HIV viral load suppression

“…These factors have also been reported in previous studies. 2,3 Of note, the authors also found that black African men and women had higher rates of viral rebound, a finding that was also shown in a study investigating protease inhibitor monotherapy in the UK. 4 Lower initial rates of viral suppression after starting ART have been commonly reported in African Americans 5 and Indigenous communities in Canada, 6 but not in Aboriginal people in Australia.…”

Inequalities in HAART uptake and differential survival according to exposure category in Rio de Janeiro, Brazil

“…As expected we found a significant interaction between the two laboratory variables (CD4+ counts and HIV-1 RNV viral load). Baseline CD4+ count (cells/mm 3 ) is predictive of virologic failure and AIDS-related mortality 36,37 and, due to the strong interaction between these two laboratory variables, we decided to exclude HIV-1 RNA viral load from our final model. We also identified a significant interaction between education and ethnicity, and decided to include it in our final models ethnicity instead of education level as the key socioeconomic status variable.…”

Cell-associated HIV-1 RNA predicts viral rebound and disease progression after discontinuation of temporary early ART

“…Indeed, cell-associated (CA) HIV-1 RNA has been demonstrated to predict ART failure and to correlate with adherence to therapy in virologically suppressed individuals (2,3), indicating that this marker could be of use in clinical care of individuals on otherwise-suppressive ART because it is more sensitive than plasma VL for associations with certain clinical endpoints. Pre-ART plasma VL, CD4 + T cell count, and total HIV-1 DNA have been shown to predict the rates of virological suppression on ART (4)(5)(6). However, to the best of our knowledge, the predictive value of CA RNA for the response to ART has not yet been reported.…”