Journal article
Transient detectable viremia and the risk of viral rebound in patients from the Swiss HIV Cohort Study.
- Young J Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland. James.Young@usb.ch.
- Rickenbach M Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland. Martin.Rickenbach@chuv.ch.
- Calmy A Division of Infectious Diseases, University Hospital Geneva, Geneva, Switzerland. Alexandra.Calmy@hcuge.ch.
- Bernasconi E Division of Infectious Diseases, Regional Hospital of Lugano, Lugano, Switzerland. Enos.Bernasconi@eoc.ch.
- Staehelin C Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland. Cornelia.Staehelin@insel.ch.
- Schmid P Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St Gallen, Switzerland. Patrick.Schmid@kssg.ch.
- Cavassini M Division of Infectious Diseases, University Hospital Lausanne, Lausanne, Switzerland. Matthias.Cavassini@chuv.ch.
- Battegay M Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland. Manuel.Battegay@usb.ch.
- Günthard HF Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zürich, Zurich, Switzerland. Huldrych.Guenthard@usz.ch.
- Bucher HC Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland. Heiner.Bucher@usb.ch.
- 2015-09-23
Published in:
- BMC infectious diseases. - 2015
Adult
Anti-HIV Agents
Cohort Studies
Female
HIV Infections
Humans
Male
Middle Aged
Proportional Hazards Models
RNA, Viral
Risk
Viral Load
Viremia
English
BACKGROUND
Temporary increases in plasma HIV RNA ('blips') are common in HIV patients on combination antiretroviral therapy (cART). Blips above 500 copies/mL have been associated with subsequent viral rebound. It is not clear if this relationship still holds when measurements are made using newer more sensitive assays.
METHODS
We selected antiretroviral-naive patients that then recorded one or more episodes of viral suppression on cART with HIV RNA measurements made using more sensitive assays (lower limit of detection below 50 copies/ml). We estimated the association in these episodes between blip magnitude and the time to viral rebound.
RESULTS
Four thousand ninety-four patients recorded a first episode of viral suppression on cART using more sensitive assays; 1672 patients recorded at least one subsequent suppression episode. Most suppression episodes (87 %) were recorded with TaqMan version 1 or 2 assays. Of the 2035 blips recorded, 84 %, 12 % and 4 % were of low (50-199 copies/mL), medium (200-499 copies/mL) and high (500-999 copies/mL) magnitude respectively. The risk of viral rebound increased as blip magnitude increased with hazard ratios of 1.20 (95 % CI 0.89-1.61), 1.42 (95 % CI 0.96-2.19) and 1.93 (95 % CI 1.24-3.01) for low, medium and high magnitude blips respectively; an increase of hazard ratio 1.09 (95 % CI 1.03 to 1.15) per 100 copies/mL of HIV RNA.
CONCLUSIONS
With the more sensitive assays now commonly used for monitoring patients, blips above 200 copies/mL are increasingly likely to lead to viral rebound and should prompt a discussion about adherence.
Temporary increases in plasma HIV RNA ('blips') are common in HIV patients on combination antiretroviral therapy (cART). Blips above 500 copies/mL have been associated with subsequent viral rebound. It is not clear if this relationship still holds when measurements are made using newer more sensitive assays.
METHODS
We selected antiretroviral-naive patients that then recorded one or more episodes of viral suppression on cART with HIV RNA measurements made using more sensitive assays (lower limit of detection below 50 copies/ml). We estimated the association in these episodes between blip magnitude and the time to viral rebound.
RESULTS
Four thousand ninety-four patients recorded a first episode of viral suppression on cART using more sensitive assays; 1672 patients recorded at least one subsequent suppression episode. Most suppression episodes (87 %) were recorded with TaqMan version 1 or 2 assays. Of the 2035 blips recorded, 84 %, 12 % and 4 % were of low (50-199 copies/mL), medium (200-499 copies/mL) and high (500-999 copies/mL) magnitude respectively. The risk of viral rebound increased as blip magnitude increased with hazard ratios of 1.20 (95 % CI 0.89-1.61), 1.42 (95 % CI 0.96-2.19) and 1.93 (95 % CI 1.24-3.01) for low, medium and high magnitude blips respectively; an increase of hazard ratio 1.09 (95 % CI 1.03 to 1.15) per 100 copies/mL of HIV RNA.
CONCLUSIONS
With the more sensitive assays now commonly used for monitoring patients, blips above 200 copies/mL are increasingly likely to lead to viral rebound and should prompt a discussion about adherence.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1186/s12879-015-1120-8
- PMID 26392270
- Persistent URL
- https://sonar.ch/global/documents/247269
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