Is HIV-1 viraemia below 20 copies/mL in antiretroviral-treated patients associated with virologic outcome?. Issue 4 (3rd April 2019)

• Record Type: Journal Article
• Authors: den Oudsten, Myriam; van Kampen, Jeroen; Rijnders, Bart; van de Vijver, David; van der Ende, Marchina
• Is Part Of: Infectious diseases. Volume 51:Issue 4(2019)
• Page Start: 259
• Page End: 267
• Publication Date: 2019-04-03
• Subjects: HIV -- viral load assay -- very low-level HIV-1 viraemia -- ART -- virologic failure; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; 616.9
• DOI: 10.1080/23744235.2018.1554909
• Languages: English
• ISSNs: 2374-4235

Abstract

Abstract: Background: We aimed to investigate whether very low-level HIV-1 viraemia (VLLV) <20 copies/mL in HIV-1-infected patients on antiretroviral therapy (ART) whose VL was <20 copies/mL, was associated with a subsequent VL > 20 copies/mL. Methods: VLLV was defined as VL <20 copies/mL and positive HIV-1-PCR. We compared patients with positive and negative HIV-1-PCRs <20 copies/mL at two time points, T0 and T1, after 21st of January 2016. Factors associated with a VLLV and subsequent VL >20 copies/mL were identified by logistic regression models. Results: Of 1341 participants at T0, 958 (71.4%) had a negative and 383 patients (28.6%) had positive HIV-RNA PCR signal during VL < 20 copies/mL. The negative relative to the positive signal at T0 was independently associated with dolutegravir (DTG) mono and/or DTG-lamivudine dual therapy (compared to nevirapine), a pre-ART-VL of 1000–9999 copies/mL (compared to ≥100, 000 copies/mL), and each additional year of virologic suppression. Having a virolologic outcome at T1 of ≥ 20 copies/mL was independently associated with prior positive signal at T0. (OR = 2.291, 95% CI = 1.457–3.601, p value < .001), a past ART interruption, and a change in ART regimen during follow-up. Each additional year of virologic suppression was independently associated with a lower risk for a subsequent VL ≥ 20 copies/mL. Conclusions: A positive HIV-1 RNA PCR <20 copies/mL at T0, was associated with a subsequent VL ≥ 20 copies/mL at T1. This was not a rare phenomenon among patients with VL <20 copies/mL. In most patients with a positive PCR signal, this was not followed by a clinically relevant HIV-1 viraemia, defined as ≥ 200 copies/mL.