Transient detectable viremia and the risk of viral rebound in patients from the Swiss HIV Cohort Study

BMC Infectious Diseases

Research Article

Jim Young¹  Heiner C. Bucher²  Cornelia Staehelin³  Patrick Schmid⁴  Manuel Battegay⁵  Huldrych F. Günthard⁶  Enos Bernasconi⁷  Alexandra Calmy⁸  Matthias Cavassini⁹  Martin Rickenbach^1,10 

[1] Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland;Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland;Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland;Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland;Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St Gallen, Switzerland;Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland;Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zürich, Zurich, Switzerland;Division of Infectious Diseases, Regional Hospital of Lugano, Lugano, Switzerland;Division of Infectious Diseases, University Hospital Geneva, Geneva, Switzerland;Division of Infectious Diseases, University Hospital Lausanne, Lausanne, Switzerland;Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland;

关键词: HIV;    Combination antiretroviral therapy;    Viral load;    Transient viremia;    Adherence;   

DOI  :  10.1186/s12879-015-1120-8

 received in 2015-03-04, accepted in 2015-09-11,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundTemporary increases in plasma HIV RNA ('blips') are common in HIV patients on combination antiretroviral therapy (cART). Blips above 500 copies/mL have been associated with subsequent viral rebound. It is not clear if this relationship still holds when measurements are made using newer more sensitive assays.MethodsWe selected antiretroviral-naive patients that then recorded one or more episodes of viral suppression on cART with HIV RNA measurements made using more sensitive assays (lower limit of detection below 50 copies/ml). We estimated the association in these episodes between blip magnitude and the time to viral rebound.ResultsFour thousand ninety-four patients recorded a first episode of viral suppression on cART using more sensitive assays; 1672 patients recorded at least one subsequent suppression episode. Most suppression episodes (87 %) were recorded with TaqMan version 1 or 2 assays. Of the 2035 blips recorded, 84 %, 12 % and 4 % were of low (50–199 copies/mL), medium (200–499 copies/mL) and high (500–999 copies/mL) magnitude respectively. The risk of viral rebound increased as blip magnitude increased with hazard ratios of 1.20 (95 % CI 0.89-1.61), 1.42 (95 % CI 0.96-2.19) and 1.93 (95 % CI 1.24-3.01) for low, medium and high magnitude blips respectively; an increase of hazard ratio 1.09 (95 % CI 1.03 to 1.15) per 100 copies/mL of HIV RNA.ConclusionsWith the more sensitive assays now commonly used for monitoring patients, blips above 200 copies/mL are increasingly likely to lead to viral rebound and should prompt a discussion about adherence.

【 授权许可】

CC BY   
© Young et al. 2015