Very low level viraemia and risk of virological failure in treated <scp>HIV</scp>‐1‐infected patients

Teira, Ramón; Vidal, Francesc; Muñoz-Sánchez, Pepa; Geijo, Paloma; Viciana, Pompeyo; Ribera, Esteve; Domingo, Peré; Castaño, Manuel; Martínez, Elisa; Roca, Bernardino; Puig, Teresa; Estrada, Vicente; Deig, Elisabeth; Galindo, MJ; Fuente, Belén de la; Lozano, Fernando; Montero, Marta; Muñoz-Sanz, Agustín; Sánchez, Trinitario; Terrón, Alberto; Romero-Palacios, Alberto; Lacalle-Remigio, Juan R.; Garrido, Myriam; Suárez-Lozano, Ignacio

doi:10.1111/hiv.12413

Cited by 23 publications

(22 citation statements)

References 17 publications

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“…Multiple potential factors could explain these differences, including different ART regimens and frequency of testing 6 . However, because of the strict definition of VF used in this study, the occurrence of VF was substantially lower than previous reported data on both resource-rich regions 38,39 and resource-limited regions 2,7 . In a recent study from South Africa, 26% VF according to standard of WHO (VL > 1000 copies/ml once) showed spontaneous control of viral replication without changing treatment regimen, and therefore should not be considered as true VF 2 .…”

Section: Discussioncontrasting

confidence: 74%

Factors associated with high-risk low-level viremia leading to virologic failure: 16-year retrospective study of a Chinese antiretroviral therapy cohort

Zhang¹,

Ding²,

An³

et al. 2020

Preprint

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Background: Low level viremia (LLV) often occurs during antiretroviral therapy (ART) against HIV-1. However, whether LLV increases the risk of virologic failure (VF) is controversial because of the non-uniform definitions of LLV and VF. Methods: A long-term first line regimen ART cohort from 2002–2018 from Shenyang, northeast China, was retrospectively studied. All participants were followed up every 3 to 6 months to evaluate the treatment effect. The high-risk LLV subgroups leading to VF (with strict standards) were explored with Cox proportional hazards model and linear mixed-effect model. The association factors of high-risk LLV were further explored using multivariate logistic regression analyses. Results: A total of 2155 HIV-1 infected participants were included; of these, 38.7% showed LLV. Both high level LLV (HLLV) and any other level LLV coupled with high level blip (HLB) showed higher risk of VF (hazards ratios, HRHLLV=5.93, and HRHLB=2.84, p<0.05 respectively). Moreover, HR increased with prolonged duration of LLV. Independent factors associated with high-risk LLV included the zenith baseline viral load (VL) above 6 log copies/ml (aOR=3.49, p=0.002), nadir baseline CD4+T cell counts below 200 cells/mm3 (aOR=1.78, p=0.011), Manchu (aOR=2.03, p=0.003), ART over 60 months (aOR=1.81, p=0.004), AZT+3TC+NVP (aOR=2.26, p<0.001) or DDI-based regimen (aOR=9.96, p=0.002), and subtype B’ infection (aOR=8.22, p=0.001). Conclusions: In case of VF with strict standards, high-risk LLV leading to VF includes VL above 400 copies/ml, occurring at least once. Serious laboratory indicators or advanced stage of infection, long term ART and subtype B’ infection might also predict the occurrence of high-risk LLV.

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Section: Discussioncontrasting

confidence: 74%

Factors associated with high-risk low-level viremia leading to virologic failure: 16-year retrospective study of a Chinese antiretroviral therapy cohort

Zhang¹,

Ding²,

An³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Multiple potential factors could explain these differences, including different ART regimens and frequency of testing [6]. However, because of the strict definition of VF used in this study, the occurrence of VF was substantially lower than previous reported data on both resource-rich regions [38,39] and resource-limited regions [2,7]. In a recent study from South Africa, 26% VF according to standard of WHO (VL > 1000 copies/ml once) showed spontaneous control of viral replication without changing treatment regimen, and therefore should not be considered as true VF [2].…”

Section: Discussionmentioning

confidence: 62%

“…The majority of the participants were male (92.9%, 2001/2155), with a Fig. 1 Flowchart showing selection of the participants median age at HIV diagnosis of 37 years old (IQR: [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. They mainly comprised of the Han nationality (85.4%).…”

Section: Characteristics Of Participants In This Studymentioning

confidence: 99%

Factors associated with high-risk low-level viremia leading to virologic failure: 16-year retrospective study of a Chinese antiretroviral therapy cohort

Zhang

Ding

et al. 2020

BMC Infect Dis

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Background: Low level viremia (LLV) often occurs during antiretroviral therapy (ART) against HIV-1. However, whether LLV increases the risk of virologic failure (VF) is controversial because of the non-uniform definitions of LLV and VF. Methods: A long-term first line regimen ART cohort from 2002 to 2018 from Shenyang, northeast China, was retrospectively studied. All participants were followed up every 3 to 6 months to evaluate the treatment effect. The high-risk LLV subgroups leading to VF (with strict standards) were explored with Cox proportional hazards model and linear mixed-effect model. The association factors of high-risk LLV were further explored using multivariate logistic regression analyses. Results: A total of 2155 HIV-1 infected participants were included; of these, 38.7% showed LLV. Both high level LLV (HLLV) and any other level LLV coupled with high level blip (HLB) showed higher risk of VF (hazards ratios, HR HLLV = 5.93, and HR HLB = 2.84, p < 0.05 respectively). Moreover, HR increased with prolonged duration of LLV. Independent factors associated with high-risk LLV included the zenith baseline viral load (VL) above 6 log copies/ml (aOR = 3.49, p = 0.002), nadir baseline CD4 + T cell counts below 200 cells/mm 3 (aOR = 1.78, p = 0.011), Manchu (aOR = 2.03, p = 0.003), ART over 60 months (aOR = 1.81, p = 0.004), AZT + 3TC + NVP (aOR = 2.26, p < 0.001) or DDI-based regimen (aOR = 9.96, p = 0.002), and subtype B′ infection (aOR = 8.22, p = 0.001). Conclusions: In case of VF with strict standards, high-risk LLV leading to VF includes VL above 400 copies/ml, occurring at least once. Serious laboratory indicators or advanced stage of infection, long term ART and subtype B′ infection might also predict the occurrence of high-risk LLV.

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“…Consequently, patients with LLV may be at increased risk of virological failure [15–21]. However, other investigators have failed to identify such an association [22, 23], and the level of viremia at which the risk of virological failure becomes significant remains controversial.…”

Section: Introductionmentioning

confidence: 99%

Virological failure and all-cause mortality in HIV-positive adults with low-level viremia during antiretroviral treatment

et al. 2017

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ObjectiveAlthough most HIV-infected individuals achieve undetectable viremia during antiretroviral therapy (ART), a subset have low-level viremia (LLV) of varying duration and magnitude. The impact of LLV on treatment outcomes is unclear. We investigated the association between LLV and virological failure and/or all-cause mortality among Swedish patients receiving ART.MethodsHIV-infected patients from two Swedish HIV centers were identified from the nationwide register InfCare HIV. Subjects aged ≥15 years with triple agent ART were included at 12 months after treatment initiation if ≥2 following viral load measurements were available. Patients with 2 consecutive HIV RNA values ≥1000 copies/mL at this time point were excluded. Participants were stratified into four categories depending on viremia profiles: permanently suppressed viremia (<50 copies/mL), LLV 50–199 copies/mL, LLV 200–999 copies/mL and viremia ≥1000 copies/mL. Association between all four viremia categories and all-cause death was calculated using survival analysis with viremia as a time-varying covariate, so that patients could change viremia category during follow-up. Association between the three lower categories and virological failure (≥2 consecutive measurements ≥1000 copies/mL) was calculated in a similar manner.ResultsLLV 50–199 copies/mL was recorded in 70/1015 patients (6.9%) and LLV 200–999 copies/mL in 89 (8.8%) during 7812 person-years of follow-up (median 6.5 years). LLV 200–999 copies/mL was associated with virological failure (adjusted hazard ratio 3.14 [95% confidence interval 1.41–7.03, p<0.01]), whereas LLV 50–199 copies/mL was not (1.01 [0.34–4.31, p = 0.99]; median follow-up 4.5 years). LLV 200–999 copies/mL had an adjusted mortality hazard ratio of 2.29 (0.98–5.32, p = 0.05) and LLV 50–199 copies/mL of 2.19 (0.90–5.37, p = 0.09).ConclusionsIn this Swedish cohort followed during ART for a median of 4.5 years, LLV 200–999 copies/mL was independently associated with virological failure. Patients with LLV had higher rates of all-cause mortality, although not statistically significant in multivariate analysis.

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Very low level viraemia and risk of virological failure in treated HIV‐1‐infected patients

Abstract: In our population of HIV-infected patients on ART who achieved viral suppression at < 20 copies/mL, the risk of virological failure was no different for patients who remained fully suppressed compared with those who experienced subsequent episodes of VLLV.

Cited by 23 publications

References 17 publications

Factors associated with high-risk low-level viremia leading to virologic failure: 16-year retrospective study of a Chinese antiretroviral therapy cohort

Factors associated with high-risk low-level viremia leading to virologic failure: 16-year retrospective study of a Chinese antiretroviral therapy cohort

Factors associated with high-risk low-level viremia leading to virologic failure: 16-year retrospective study of a Chinese antiretroviral therapy cohort

Virological failure and all-cause mortality in HIV-positive adults with low-level viremia during antiretroviral treatment

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