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Factors Associated with Low-Level Viraemia and Virological Failure: Results from the Austrian HIV Cohort Study.

Leierer G, Grabmeier-Pfistershammer K, Steuer A, Geit M, Sarcletti M, Haas B, Kanatschnig M, Rappold M, Zangerle R, Ledergerber B, Taylor N, Austrian HIV Cohort Study Gro - PLoS ONE (2015)

Bottom Line: Factors associated with LLV and VF compared to BLQ were identified by logistic regression models.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and Venereology, Medical University of Innsbruck, Innsbruck, Austria.

ABSTRACT

Background: 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).

Materials and methods: 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.

Results: 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)].

Conclusions: 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.

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Related in: MedlinePlus

Flowchart of patient selection.
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pone.0142923.g001: Flowchart of patient selection.

Mentions: The flowchart of the patient selection is shown in Fig 1 and the characteristics of the 2276 included participants, stratified by HIV RNA levels are listed in Table 1. For all the patients included in the study, the median age was 43.8 years (interquartile range IQR: 36.6–51.6) and the majority were men (72.1%). cART was PI-based in 42.9% (976/2276) of the patients, with darunavir being mostly used. NNRTI- and INSTI-based therapies were used in 57.1% (1300/2276) of the cases. The median time on cART was 68.4 months (IQR: 32.0–129.8). Seventy eight percent of the participants had their HIV RNA measured by the Roche assay and 22% had their HIV RNA measured using the Abbott assay. 773 did not have a VL measurement within 12 months of respective cART initiation and were excluded. 377 (16.6%) patients had no prior cART. 1972 of the 2276 included patients were BLQ (86.4%), while 222 (9.8%) showed a LLV and 82 (3.6%) had VF. Stratification by VL of sociodemographic and laboratory analyses showed a higher frequency of male injecting drug users (12.6 and 22.0 versus 8.8%) and of patients with cART interruptions (32.0 and 48.8 versus 24.1%) in the LLV and VF group compared to patients who were BLQ. PI-based regimens were more frequent (65.9 and 51.4 versus 41.0%). Patients whose HIV RNA was measured by the Roche assay rather than by the Abbott assay had more quantifiable VL measurements ≥200 copies/mL and below 200 copies/mL compared to individuals who were BLQ (96.3 and 90.5 versus 75.9%). A higher VL before cART (>99.999 copies/mL: 50.0% versus 36.9%) was more likely to be found in patients with LLV. Patients with VF were younger (<30 years: 12.2 versus 8.5%; 30–50 years: 78.1 versus 64.8%) and more likely originating from high prevalence countries (18.3 versus 8.8%). Concerning VL cases, the majority (35.4%) of the VF cases were below 1000 copies/mL and only 6.1% reached very high VLs (>99.000 copies/mL).


Factors Associated with Low-Level Viraemia and Virological Failure: Results from the Austrian HIV Cohort Study.

Leierer G, Grabmeier-Pfistershammer K, Steuer A, Geit M, Sarcletti M, Haas B, Kanatschnig M, Rappold M, Zangerle R, Ledergerber B, Taylor N, Austrian HIV Cohort Study Gro - PLoS ONE (2015)

Flowchart of patient selection.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4643888&req=5

pone.0142923.g001: Flowchart of patient selection.
Mentions: The flowchart of the patient selection is shown in Fig 1 and the characteristics of the 2276 included participants, stratified by HIV RNA levels are listed in Table 1. For all the patients included in the study, the median age was 43.8 years (interquartile range IQR: 36.6–51.6) and the majority were men (72.1%). cART was PI-based in 42.9% (976/2276) of the patients, with darunavir being mostly used. NNRTI- and INSTI-based therapies were used in 57.1% (1300/2276) of the cases. The median time on cART was 68.4 months (IQR: 32.0–129.8). Seventy eight percent of the participants had their HIV RNA measured by the Roche assay and 22% had their HIV RNA measured using the Abbott assay. 773 did not have a VL measurement within 12 months of respective cART initiation and were excluded. 377 (16.6%) patients had no prior cART. 1972 of the 2276 included patients were BLQ (86.4%), while 222 (9.8%) showed a LLV and 82 (3.6%) had VF. Stratification by VL of sociodemographic and laboratory analyses showed a higher frequency of male injecting drug users (12.6 and 22.0 versus 8.8%) and of patients with cART interruptions (32.0 and 48.8 versus 24.1%) in the LLV and VF group compared to patients who were BLQ. PI-based regimens were more frequent (65.9 and 51.4 versus 41.0%). Patients whose HIV RNA was measured by the Roche assay rather than by the Abbott assay had more quantifiable VL measurements ≥200 copies/mL and below 200 copies/mL compared to individuals who were BLQ (96.3 and 90.5 versus 75.9%). A higher VL before cART (>99.999 copies/mL: 50.0% versus 36.9%) was more likely to be found in patients with LLV. Patients with VF were younger (<30 years: 12.2 versus 8.5%; 30–50 years: 78.1 versus 64.8%) and more likely originating from high prevalence countries (18.3 versus 8.8%). Concerning VL cases, the majority (35.4%) of the VF cases were below 1000 copies/mL and only 6.1% reached very high VLs (>99.000 copies/mL).

Bottom Line: Factors associated with LLV and VF compared to BLQ were identified by logistic regression models.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and Venereology, Medical University of Innsbruck, Innsbruck, Austria.

ABSTRACT

Background: 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).

Materials and methods: 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.

Results: 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)].

Conclusions: 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.

Show MeSH
Related in: MedlinePlus