Time spent with HIV-RNA ⩽ 200 copies/ml in a cohort of people with HIV during the U=U era. (1st June 2021)

• Record Type: Journal Article
• Authors: Madeddu, Giordano; De Vito, Andrea; Cozzi-Lepri, Alessandro; Cingolani, Antonella; Maggiolo, Franco; Perno, Carlo Federico; Gagliardini, Roberta; Marchetti, Giulia; Saracino, Annalisa; Monforte, Antonella d'Arminio; Antinori, Andrea; Girardi, Enrico
• Is Part Of: AIDS. Volume 35:Number 7(2021)
• Publication Date: 2021-06-01
• Subjects: combination antiretroviral therapy -- HIV -- transmission -- U=U message; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000002825
• Languages: English
• ISSNs: 0269-9370

Abstract

Abstract : Objective: Zero risk of linked HIV transmission in serodiscordant couples when the HIV-infected partner had viral load less than 200 copies/ml ('U status') was found in observational studies. We aimed at estimating the proportion of time in which 'U status' was maintained and identifying factors associated with the risk of losing it. Design: Observational cohort study. Methods: We included participants in the ICONA cohort who had reached an established 'U status' (viral load ⩽200 copies/ml for >6 months) as of December 2010. The outcome was the number of person-days of follow-up (PDFU) above a viral load greater than 200 copies/ml, relative to the total number of PDFU observed. A logistic regression model was used to identify factors independently associated with the risk of losing 'U status'. Results: Eight thousand, two hundred and forty-one persons living with HIV were included in the analysis who contributed 2 670 888 PDFU. Of these, 1648 (20%) were women, 768 (9%) were people who inject drugs (PWID), and 2066 (25%) were foreign-born. The median of viral load measurements was 9 (IQR: 4–15). Overall, only 3.1% of PDFU were observed when viral load was above 200 copies/ml. The proportion of PDFU with viral load more than 200 copies/ml was higher than average in women (5.3%), unemployed (5.4%), PWID (4.7%), and in people with more than three previous virologic failures (6.3%). These variables were significant predictors of losing 'U status' in the multivariable logistic regression. Conclusion: Our results reinforce the validity of the U=U message in real-world setting. However, we identified subsets of our study population at higher risk of losing the 'U status' for whom additional efforts are needed. Abstract : Supplemental Digital Content is available in the text