Persistent Low-level Viremia Predicts Subsequent Virologic Failure: Is It Time to Change the Third 90?

被引:62
作者
Esber, Allahna [1 ,2 ]
Polyak, Christina [1 ,2 ]
Kiweewa, Francis [3 ]
Maswai, Jonah [4 ]
Owuoth, John [5 ]
Maganga, Lucas [6 ]
Adamu, Yakubu [7 ]
Hickey, Patrick W. [8 ]
Ake, Julie A. [1 ]
Crowell, Trevor A. [1 ,2 ]
机构
[1] Walter Reed Army Inst Res, US Mil Human Immunodeficiency Virus Res Program, Silver Spring, MD USA
[2] Henry M Jackson Fdn HJF Adv Mil Med, Bethesda, MD USA
[3] Makerere Univ, Walter Reed Project, Kampala, Uganda
[4] HJF Med Res Int, Kericho, Kenya
[5] HJF Med Res Int, Kisumu, Kenya
[6] Mbeya Med Res Ctr, Mbeya, Tanzania
[7] US Army Med Res Directorate Africa Nigeria, Abuja, Nigeria
[8] Uniformed Serv Univ Hlth Sci, Dept Pediat, Bethesda, MD USA
关键词
HIV; low-level viremia; virologic failure; ART; ANTIRETROVIRAL THERAPY; HIV-1-INFECTED PATIENTS; RECURRENT EVENTS; HIV; MORTALITY; MORBIDITY; RISK; MANAGEMENT; HAART; AIDS;
D O I
10.1093/cid/ciy989
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background World Health Organization (WHO) guidelines identify human immunodeficiency virus (HIV) viral load <1000 copies/mL as the goal of antiretroviral therapy (ART). However, the clinical implications of viremia below this threshold are unclear in the African context. We examined factors associated with persistent low-level viremia (pLLV) and quantified the risk of subsequent virologic. Methods The African Cohort Study enrolled HIV-infected adults at clinics in Uganda, Kenya, Tanzania, and Nigeria, with assessments every 6 months. We evaluated participants prescribed ART for at least 6 months without virologic failure for pLLV. We used multinomial logistic regression to evaluate associations between prespecified factors of interest and 3 levels of pLLV (<200, 200-499, and 500-999 copies/mL). We used Anderson-Gill extended Cox proportional hazards to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for viremia category associations with time to failure. Results We included 1511 participants with 4382 person-years of follow-up. PLLV <200 copies/mL was observed at 20% of visits while 2% of visits had pLLV 200-499 and 500-999 copies/mL each, with substantial variation by site. Protease inhibitor-containing ART was associated with increased risk of pLLV. Compared to undetectable viral load, pLLV >= 200 copies/mL doubled the risk of developing virologic failure (pLLV 200-499: HR, 1.81 [95% CI, 1.08-3.02]); pLLV 500-999: HR, 2.36 [95% CI, 1.52-3.67]). Conclusions Participants with pLLV >= 200 copies/mL were at increased risk of subsequent virologic failure. Optimized HIV care in this setting should target viral suppression <200 copies/mL.
引用
收藏
页码:805 / 812
页数:8
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