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Any impact of blips and low-level viraemia episodes among HIV-infected patients with sustained virological suppression on ART?

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Title
Any impact of blips and low-level viraemia episodes among HIV-infected patients with sustained virological suppression on ART?
Author(s)
Pernas, Berta
Grandal, Marta
Pértega-Díaz, Sonia
Cañizares, Angelina
Castro-Iglesias, Ángeles
Mena, Álvaro
Rodríguez-Osorio, Iria
Tabernilla, Andrés
Pedreira, José D.
Poveda, Eva
Date
2015-12-24
Citation
Pernas B, Grandal M, Pértega S, et al. Any impact of blips and low-level viraemia episodes among HIV-infected patients with sustained virological suppression on ART?. J Antimicrob Chemother. 2016;71(4):1051-1055
Abstract
[Abstract] Objectives. The objective of this study was to evaluate the prevalence of blips and risk of virological failure (VF) among HIV-infected patients with sustained virological suppression (HIV-RNA <50 copies/mL) on ART. Methods. Newly diagnosed (2004–13) HIV-infected patients with sustained virological suppression on ART (minimum follow-up of 3 months) were identified. Risk of VF was evaluated according to different plasma HIV-RNA quantification values based on the limits of quantification/detection of current commercial assays (20 copies/mL). Kaplan–Meier and Cox proportional hazards models were used to compare the cumulative incidence of VF. Results. A total of 565 newly diagnosed HIV-infected patients were identified: 453 started ART and 354 achieved virological suppression. Prevalence of blips (isolated HIV-RNA ranging from 50 to 200 copies/mL) and VF (HIV-RNA ≥50 copies/mL) was 22.7% and 8.8%, respectively (mean follow-up of 42 months). Multivariate analysis identified differences between HIV-RNA values as an independent predictor of VF (P = 0.008); risk of VF was higher for patients with blips [HR 2.500 (95% CI 0.524–11.926)] and for those with at least three consecutive detected, but not quantified, HIV-RNA determinations (HIV-RNA <20 copies/mL) [HR 3.813 (95% CI 0.675–21.535)]. Moreover, only HIV-infected patients with at least three consecutive detected, but not quantified, HIV-RNA determinations showed a higher probability of virological rebound with >200 copies/mL [33.7% at 24 and 60 months versus <5% for other HIV-RNA values; HR 6.943 (0.728–66.261), P = 0.092]. Conclusions. Blips are frequent (22.7%) among HIV-infected patients with sustained virological suppression on ART. HIV patients with blips and at least three consecutive detected, but not quantified, HIV-RNA determinations (<20 copies/mL) had a higher risk of VF. These findings highlight the relevance of maintaining HIV-RNA levels below the limits of quantification of current assays (<20 copies/mL).
Keywords
HIV
Follow-up
Plasma
Viremia
Virology
Blood HIV RNA
HIV infection
 
Editor version
https://doi.org/10.1093/jac/dkv433
Rights
This is a pre-copyedited, author-produced version of an article accepted for publication in "Journal of Antimicrobial Chemotherapy" following peer review. The version of record is avaliable online at Oxford Academic
ISSN
0305-7453
1460-2091
 

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