en
Scientific article
Open access
English

Transient detectable viremia and the risk of viral rebound in patients from the Swiss HIV Cohort Study

Published inBMC infectious diseases, vol. 15, 382
Publication date2015-09-21
First online date2015-09-21
Abstract

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.

eng
Keywords
  • Adult
  • Anti-HIV Agents / therapeutic use
  • Cohort Studies
  • Female
  • HIV Infections / diagnosis
  • HIV Infections / drug therapy
  • HIV Infections / virology
  • Humans
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • RNA, Viral / blood
  • Risk
  • Viral Load
  • Viremia / diagnosis
  • Viremia / virology
Research group
Citation (ISO format)
YOUNG, Jim et al. Transient detectable viremia and the risk of viral rebound in patients from the Swiss HIV Cohort Study. In: BMC infectious diseases, 2015, vol. 15, p. 382. doi: 10.1186/s12879-015-1120-8
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Article (Published version)
Identifiers
ISSN of the journal1471-2334
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