Younger Age Predicts Failure to Achieve Viral Suppression and Virologic Rebound among HIV-1 Infected Persons in Serodiscordant Partnerships
BACKGROUND:
Antiretroviral
therapy (ART) markedly reduces the risk of HIV-1 transmission in serodiscordant
partnerships. We previously found that younger age and higher CD4 counts were
associated with delayed initiation of ART by HIV-1 infected partners in
serodiscordant partnerships. Among those initiating ART, we sought to explore
whether those same factors were associated with failure to achieve viral suppression.
METHODS:
In a
prospective study of HIV-1 infected persons who had a known heterosexual HIV-1
uninfected partner in Kenya and Uganda (Partners PrEP Study), we used Cox
proportional hazards regression to evaluate correlates of viral non-suppression
(HIV-1 RNA >80 c/mL).
RESULTS:
Of 1035
HIV-1 infected participants initiating ART, 867 (84%) achieved viral
suppression: 77% by 6 months and 86% by 12 months. Younger age (adjusted hazard
ratio [aHR] 1.05 for every 5 years younger; p=0.006), lower pre-treatment CD4
count (aHR 1.26; p=0.009 for ≤250 compared with >250 cells/µL) and higher
pre-treatment HIV-1 RNA quantity (aHR 1.21 per log10; p<0.001) independently
predicted failure to achieve viral suppression. Following initial viral
suppression, 8.8% (76/867) experienced virologic rebound (HIV-1 RNA >200
c/mL): 6.3% and 11.5% by 6 and 12 months after initial suppression,
respectively. Age was the only factor associated with increased risk of
virologic rebound (aHR 1.33 for every 5 years younger; p=0.005).
CONCLUSIONS:
For
HIV-1 infected persons in serodiscordant couples, younger age was associated
with delayed ART initiation, failure to achieve viral suppression, and
increased risk of virologic rebound. Motivating ART initiation and early
adherence is key to achieving and sustaining viral suppression.
- 1University of Washington, Department of Global Health , 901 Boren Ave , Suite 1300 , Seattle, Washington, United States , 98104 , 206 685 4575 , +27118845787 ; mujugira@uw.edu.
- 2University of Washington, Seattle, Washington, United States ; ccelum@uw.edu.
- 3Centers for Disease Control and Prevention, Center for Global Health, Atlanta, Georgia, United States ; jwt0@cdc.gov.
- 4University of Manitoba, Medicine and Microbiology, Winnipeg, Manitoba, Canada ; Allan.Ronald@umanitoba.ca.
- 5Kenya Medical Research Institute, Nairobi, Kenya ; rwamba@uw.edu.
- 6University of Washington, Seattle, Washington, United States ; jbaeten@uw.edu.
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