In human immunodeficiency virus treatment adequate
virological suppression is warranted, nevertheless for some patients it remains
a challenge. We investigated factors associated with low-level viraemia (LLV)
and virological failure (VF) under combined antiretroviral therapy (cART).
We analysed patients receiving standard regimens between 1st July 2012 and 1st July
2013 with at least one viral load (VL) measurement below the quantification
limit (BLQ) in their treatment history. After a minimum of 6 months of
unmodified cART, the next single VL measurement within 6 months was analysed.
VF was defined as HIV RNA levels ≥200 copies/mL and all other quantifiable
measurements were classified as LLV. Factors associated with LLV and VF
compared to BLQ were identified by logistic regression models.
Of 2276 participants, 1972 (86.6%) were BLQ, 222 (9.8%)
showed LLV and 82 (3.6%) had VF. A higher risk for LLV and VF was shown in
patients with cART interruptions and in patients with boosted PI therapy. The
risk for LLV and VF was lower in patients from centres using the Abbott
compared to the Roche assay to measure VL. A higher risk for LLV but not for VF
was found in patients with a higher VL before cART [for >99.999 copies/mL:
aOR (95% CI): 4.19 (2.07–8.49); for 10.000–99.999 copies/mL: aOR (95% CI): 2.52
(1.23–5.19)] and shorter cART duration [for <9 months: aOR (95% CI): 2.59
(1.38–4.86)]. A higher risk for VF but not for LLV was found in younger
patients [for <30 years: aOR (95% CI): 2.76 (1.03–7.35); for 30–50 years:
aOR (95% CI): 2.70 (1.26–5.79)], people originating from high prevalence
countries [aOR (95% CI): 2.20 (1.09–4.42)] and in male injecting drug users
[aOR (95% CI): 2.72 (1.38–5.34)].
For both VF and LLV, factors associated with adherence play
a prominent role. Furthermore, performance characteristics of the diagnostic
assay used for VL quantification should also be taken into consideration.
Full article at: http://goo.gl/sIOuWp
By:
Gisela Leierer, Mario Sarcletti, Michaela Rappold, Robert
Zangerle
Department of Dermatology and
Venereology, Medical University of Innsbruck, Innsbruck, Austria
Gisela Leierer, Michaela Rappold
Austrian HIV Cohort Study,
Innsbruck, Austria
Katharina Grabmeier-Pfistershammer
Department of Dermatology,
Medical University of Vienna, Vienna, Austria
Andrea Steuer
Otto-Wagner Hospital, Department
of Pulmonology, Vienna, Austria
Maria Geit
Department of Dermatology,
General Hospital Linz, Linz, Austria
Bernhard Haas
Department of Internal Medicine,
General Hospital Graz-West, Graz, Austria
Manfred Kanatschnig
1st Medical Department, General
Hospital Klagenfurt, Klagenfurt, Austria
Bruno Ledergerber
Division of Infectious Diseases
and Hospital Epidemiology, University Hospital Zurich, University of Zurich,
Zurich, Switzerland
Ninon Taylor
Department of Internal Medicine
III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases,
Rheumatology, Oncologic Center, Laboratory of Immunological and Molecular
Cancer Research, Paracelsus Medical University, Salzburg, Austria
More at: https://twitter.com/hiv_insight
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