Friday, December 25, 2015

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/┬ÁL) 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.

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  • 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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