Impact of pre-antiretroviral treatment HIV-RNA on time to successful virological suppression and subsequent virological failure – two nationwide, population-based cohort studies. (1st February 2023)

• Record Type: Journal Article
• Authors: Sörstedt, Erik; Tetens, Malte Mose; Nilsson, Staffan; Nowak, Piotr; Treutiger, Carl Johan; Månsson, Fredrik; Änghagen, Lena; Gisslén, Magnus; Obel, Niels; Yilmaz, Aylin
• Is Part Of: AIDS. Volume 37:Number 2(2023)
• Page Start: 279
• Page End: 286
• Publication Date: 2023-02-01
• Subjects: antiretroviral therapy -- CD4+ nadir -- HIV-RNA -- pre-antiretroviral therapy HIV-RNA; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000003425
• Languages: English
• ISSNs: 0269-9370

Abstract

Abstract : Background: The impact of pre-antiretroviral treatment (ART) HIV-RNA on time to successful virological suppression and subsequent failure in HIV patients remains poorly investigated. Methods: We used the Swedish InfCareHIV database and the Danish HIV Cohort Study to evaluate impact of pre-ART HIV-RNA on primary virological suppression (HIV-RNA < 50 copies/ml) and risk of secondary virological failure (two consecutive HIV-RNA > 200 copies/ml or one >1000 copies/ml). The study included 3366 Swedish and 2050 Danish ART naïve individuals who initiated ART in the period 2000–2018. We used Kaplan–Meier estimates and Cox regression analyses to estimate absolute risks and hazard ratios. Results: In both cohorts, more than 95% of patients with a pre-ART HIV-RNA <100 000 copies/ml obtained virological suppression within the first year after ART initiation contrasting 74% (Sweden) and 86% (Denmark) in those with HIV-RNA >1 000 000 copies/ml. Almost all patients obtained virological suppression after four years irrespective of pre-ART HIV-RNA. In contrast, we observed no substantial impact of pre-ART HIV-RNA on risk of virological failure once virological suppression was obtained. Conclusion: High pre-ART HIV-RNA is strongly associated with increased time to successful virological suppression, but pre-ART HIV-RNA has no impact on risk of subsequent virological failure.