Virological failure and all-cause mortality in HIV-positive adults with low-level viremia during antiretroviral treatment

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Elvstam, OlofLund University,Lunds universitet,Klinisk infektionsmedicin,Forskargrupper vid Lunds universitet,Clinical infection medicine,Lund University Research Groups (author)

Virological failure and all-cause mortality in HIV-positive adults with low-level viremia during antiretroviral treatment

Article/chapterEnglish2017

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2017-07-06
Public Library of Science (PLoS),2017

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LIBRIS-ID:oai:gup.ub.gu.se/255761
https://gup.ub.gu.se/publication/255761URI
https://doi.org/10.1371/journal.pone.0180761DOI
https://lup.lub.lu.se/record/f21ea8db-a706-4f81-9b47-f40dd3ee8b0bURI

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Language:English

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SwePubSwePub

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Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

Notes

Objective Although most HIV-infected individuals achieve undetectable viremia during antiretroviral therapy (ART), a subset have low-level viremia (LLV) of varying duration and magnitude. The impact of LLV on treatment outcomes is unclear. We investigated the association between LLV and virological failure and/or all-cause mortality among Swedish patients receiving ART. HIV-infected patients from two Swedish HIV centers were identified from the nationwide register InfCare HIV. Subjects aged >= 15 years with triple agent ART were included at 12 months after treatment initiation if >= 2 following viral load measurements were available. Patients with 2 consecutive HIV RNA values >= 1000 copies/mL at this time point were excluded. Participants were stratified into four categories depending on viremia profiles: permanently suppressed viremia (<50 copies/mL), LLV 50-199 copies/mL, LLV 200-999 copies/mL and viremia >= 1000 copies/mL. Association between all four viremia categories and all-cause death was calculated using survival analysis with viremia as a time-varying covariate, so that patients could change viremia category during follow-up. Association between the three lower categories and virological failure >= 2 consecutive measurements >= 1000 copies/mL) was calculated in a similar manner. LLV 50-199 copies/mL was recorded in 70/1015 patients (6.9%) and LLV 200-999 copies/mL in 89 (8.8%) during 7812 person-years of follow-up (median 6.5 years). LLV 200-999 copies/mL was associated with virological failure (adjusted hazard ratio 3.14 [95% confidence interval 1.41-7.03, p<0.01]), whereas LLV 50-199 copies/mL was not (1.01 [0.34-4.31, p = 0.99]; median follow-up 4.5 years). LLV 200-999 copies/mL had an adjusted mortality hazard ratio of 2.29 (0.98-5.32, p = 0.05) and LLV 50-199 copies/mL of 2.19 (0.90-5.37, p = 0.09). In this Swedish cohort followed during ART for a median of 4.5 years, LLV 200-999 copies/mL was independently associated with virological failure. Patients with LLV had higher rates of all-cause mortality, although not statistically significant in multivariate analysis.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Infektionsmedicin hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Infectious Medicine hsv//eng
hiv-1-infected patients
infected patients
drug-resistance
raltegravir
intensification
general-population
copy-years
therapy
cohort
inflammation
risk

Added entries (persons, corporate bodies, meetings, titles ...)

Medstrand, PatrikLund University,Lunds universitet,Klinisk virologi, Malmö,Forskargrupper vid Lunds universitet,Clinical Virology, Malmö,Lund University Research Groups(Swepub:lu)mmb-pme (author)
Yilmaz, Aylin,1974University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för biomedicin, avdelningen för infektionssjukdomar,Institute of Biomedicine, Department of Infectious Medicine(Swepub:gu)xyilay (author)
Isberg, Per ErikLund University,Lunds universitet,Statistiska institutionen,Ekonomihögskolan,Department of Statistics,Lund University School of Economics and Management, LUSEM(Swepub:lu)stat-pis (author)
Gisslén, Magnus,1962University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för biomedicin, avdelningen för infektionssjukdomar,Institute of Biomedicine, Department of Infectious Medicine(Swepub:gu)xgissm (author)
Bjorkman, PerLund University,Lunds universitet,Klinisk infektionsmedicin,Forskargrupper vid Lunds universitet,Clinical infection medicine,Lund University Research Groups(Swepub:lu)inf-pbj (author)
Klinisk infektionsmedicinForskargrupper vid Lunds universitet (creator_code:org_t)

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In:Plos One: Public Library of Science (PLoS)12:71932-6203

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