An undetectable polymerase chain reaction signal in routine HIV plasma viral load monitoring is associated with better virological outcomes in patients receiving highly active antiretroviral therapy1. Issue 8 (8th May 2013)

• Record Type: Journal Article
• Authors: Pugliese, P; Delpierre, C; Cuzin, L; Poizot‐Martin, I; Rey, D; Saune, K; Cottalorda, J; Bettinger, D; Delaugerre, C; Hoen, B
• Is Part Of: HIV medicine. Volume 14:Issue 8(2013:Sep.)
• Page Start: 509
• Page End: 515
• Publication Date: 2013-05-08
• Subjects: HIV infections -- Treatment -- Periodicals; HIV-positive persons -- Periodicals; HIV infections -- Treatment -- Decision making -- Periodicals; 616.9792
• DOI: 10.1111/hiv.12041
• Languages: English
• ISSNs: 1464-2662

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="hiv12041-sec-0001" sec-type="section"> <title>Objectives</title> <p>The aim of the study was to assess whether patients with undetectable viraemia [a negative polymerase chain reaction result (PCR<sup>neg</sup>)] and those with plasma viral load (PVL) < 40 HIV‐1 RNA copies/mL but a detectable (positive) PCR signal (PCR<sup>pos</sup>) had different outcomes in terms of the development of blips and virological failure (VF).</p> </sec> <sec id="hiv12041-sec-0002" sec-type="section"> <title>Methods</title> <p>A multicentre observational database analysis was carried out. Data for patients whose highly active antiretroviral therapy (HAART) regime had been unchanged for ≥ 6 months by 1 January 2008, whose first two PVL measurements of 2008 were < 40 copies/mL and who had at least five PVL measurements between 1 January 2008 and 31 December 2010 were extracted from a multicentre observational database of 4928 patients receiving HAART. PVL assays used during this period had a detection threshold of 20 or 40 copies/mL. Undetectable PVL at baseline (<sub>BL</sub>PCR<sup>neg</sup>) was defined as PCR<sup>neg</sup> at the first two PVL determinations of 2008. Multivariable Cox regression analysis was performed to investigate factors associated with the occurrence of blips and VF, defined as two consecutive PVL measurements > 40 copies/mL.</p> </sec> <sec id="hiv12041-sec-0003" sec-type="section"> <title>Results</title> <p>Of the 1957 patients included in the study (mean age 47 years; median antiretroviral exposure 10.3 years), 1312 had <sub>BL</sub>PCR<sup>neg</sup>. Outcome events included 322 blips and 139 VFs, with incidence rates being significantly lower in patients with <sub>BL</sub>PCR<sup>neg</sup> than in those with <sub>BL</sub>PCR<sup>pos</sup> [13.0% <italic>vs.</italic> 23.4% (<italic>P</italic> < 0.0001) and 5.1% <italic>vs.</italic> 11.2% (<italic>P</italic> < 0.0001), respectively]. In multivariable analysis, <sub>BL</sub>PCR<sup>neg</sup> was associated with a reduced risk of blips [hazard ratio (HR) 0.58; 95% confidence interval (CI) 0.47–0.73; <italic>P</italic> < 0.0001] and VF (HR 0.44; 95% CI 0.31–0.62; <italic>P</italic> < 0.0001).</p> </sec> <sec id="hiv12041-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Patients with PCR<sup>neg</sup> had better virological outcomes than those with PVL < 40 copies/mL but detectable viraemia. This suggests that the 'no‐signal' information provided by currently commercially available HIV RNA quantification assays should be used routinely.</p> </sec> </abstract>