Predictors of incomplete viral response and virologic failure in patients with acute and early HIV infection. Results of Italian Network of ACuTe HIV InfectiON (INACTION) cohort. Issue 8 (24th June 2020)

• Record Type: Journal Article
• Authors: Taramasso, L; Fabbiani, M; Nozza, S; De Benedetto, I; Bruzzesi, E; Mastrangelo, A; Pinnetti, C; Calcagno, A; Ferrara, M; Bozzi, G; Focà, E; Quiros‐Roldan, E; Ripamonti, D; Campus, M; Celesia, BM; Torti, C; Cosco, L; Di Biagio, A; Rusconi, S; Marchetti, G; Mussini, C; Gulminetti, R; Cingolani, A; d'Ettorre, G; Madeddu, G; Franco, A; Orofino, G; Squillace, N; Muscatello, A; Gori, A; Antinori, A; Tambussi, G; Bandera, A;
• Is Part Of: HIV medicine. Volume 21:Issue 8(2020)
• Page Start: 523
• Page End: 535
• Publication Date: 2020-06-24
• Subjects: acute HIV infection -- blip -- early antiretroviral treatment -- incomplete viral response -- virologic failure; HIV infections -- Treatment -- Periodicals; HIV-positive persons -- Periodicals; HIV infections -- Treatment -- Decision making -- Periodicals; 616.9792
• DOI: 10.1111/hiv.12885
• Languages: English
• ISSNs: 1464-2662

Abstract

Abstract : Objectives: The aim of this study was to evaluate the factors that can influence an incomplete viral response (IVR) after acute and early HIV infection (AEHI). Methods: This was a retrospective, observational study including patients with AEHI (Fiebig stages I–V) diagnosed between January 2008 and December 2014 at 20 Italian centres. IVR was defined by: (1) viral blip (51–1000 HIV‐1 RNA copies/mL after achievement of < 50 HIV‐1 RNA copies/mL); (2) virologic failure [> 1000 copies/mL after achievement of < 200 copies/mL, or ≥ 200 copies/mL after 24 weeks on an antiretroviral therapy (ART)]; (3) suboptimal viral response (> 50 copies/mL after 48 weeks on ART or two consecutive HIV‐1 RNA levels with ascending trend during ART). Cox regression analysis was used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for IVR. Results: In all, 263 patients were studied, 227 (86%) males, with a median [interquartile range (IQR)] age of 38 (30–46) years. During a median follow‐up of 13.0 (5.7–31.1) months, 38 (14.4%) had IVR. The presence of central nervous system (CNS) symptoms was linked to a higher risk of IVR (HR = 4.70, 95% CI: 1.56–14.17), while a higher CD4/CD8 cell count ratio (HR = 0.13, 95% CI: 0.03–0.51 for each point increase) and first‐line ART with three‐drug regimens recommended by current guidelines (HR = 0.40, 95% CI: 0.18–0.91 compared with other regimens including four or five drugs, older drugs or non‐standard backbones) were protective against IVR. Conclusions: Patients with lower CD4/CD8 ratio and CNS symptoms could be at a higher risk of IVR after AEHI. The use of recommended ART may be relevant for improving short‐term viral efficacy in this group of patients.