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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
The natural history and clinical significance of intermittent viraemia in patients with initial viral suppression to < 400 copies/ml
AIDS, Volume 16, No. 11, Year 2002
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Description
Objectives: To determine the prevalence and prognostic significance of intermittent viraemia (IV) in patients who attained an undetectable viral load (VL) < 400 copies/ml within 6 months on highly active antiretroviral therapy (HAART). Methods: Retrospective analysis of viral load rebound ≥ 400 copies/ml and CD4 cell counts rise for 765 patients followed for ≥ 12 months following initial VL undetectability, comparing the 226 (29.5%) who maintained an undetectable VL for > 1 year from initiation of HAART and 122 (15.9%) who had one or more episodes of IV. Genotypic resistance was evaluated at the time of the first episode of IV ≥ 2000 copies/ml. Results: Patients with IV had a threefold higher rate of sustained virological rebound [hazards ratio (HR), 3.15; 95% confidence interval (CI), 1.72-5.77; P < 0.001). For patients with and without IV, the Kaplan-Meier estimates at 24 and 36 months after initiation of HAART were 19.3% (95% CI, 8.9-21.5) versus 7.7% (95% CI, 4.5-13.0) and 31.6% (95% CI, 21.8-44.2) versus 12.9% (95% CI, 7.5-21.5), respectively (P < 0.001). The median CD4 cell count rise at 18 and 24 months was significantly lower in those with IV than in those without: 138 [interquartile range (IQR), 58-221] versus 224 × 106 cells/l (IQR, 119-357) (P = 0.0001) and 200 (IQR, 89-294) versus 260 × 106 cells/l (IQR, 125-384) (P = 0.003), respectively. In a subgroup of 16 patients, genotypic resistance mutations were found in the reverse transcriptase gene for five (31%) and in the protease gene in one. A probable contributing factor/event was identified for most patients with IV, such as poor adherence (42.6%), intercurrent infection (26.2%) or drug interaction (6.8%). Conclusions: Patients with IV > 400 copies/ml are three times more likely to experience sustained viral rebound and to have an impaired CD4 cell rise relative to those who maintain undetectable VL. This supports the adoption of a more pro-active approach to treatment intensification and the need for caution with structured treatment interruptions. © 2002 Lippincott Williams & Wilkins.
Authors & Co-Authors
Easterbrook, Philippa Jane
United Kingdom, London
Faculty of Life Sciences & Medicine
Ives, Natalie J.
United Kingdom, London
Faculty of Life Sciences & Medicine
Mullen, Jane E.
United Kingdom, London
Guy's and st Thomas' Nhs Foundation Trust
O'Shea, Siobhan
United Kingdom, London
Guy's and st Thomas' Nhs Foundation Trust
Peters, Barry S.
United Kingdom, London
Guy's and st Thomas' Nhs Foundation Trust
Gazzard, Brian George L.
United Kingdom, London
Chelsea and Westminster Hospital
Statistics
Citations: 60
Authors: 6
Affiliations: 3
Identifiers
Doi:
10.1097/00002030-200207260-00009
ISSN:
02699370
Research Areas
Genetics And Genomics
Study Design
Cross Sectional Study
Cohort Study