Impact of low-level viremia on clinical and virological outcomes in treated HIV-1-infected patients

被引：100

作者：

Vandenhende, Marie-Anne ^{[1
,2
,3
]}

Ingle, Suzanne ^{[4
]}

May, Margaret ^{[4
]}

Chene, Genevieve ^{[1
,2
]}

Zangerle, Robert ^{[5
]}

Van Sighem, Ard ^{[6
]}

Gill, M. John ^{[7
]}

Schwarze-Zander, Carolynne ^{[8
]}

Hernandez-Novoa, Beatriz ^{[9
]}

Obel, Niels ^{[10
]}

Kirk, Ole ^{[10
,11
]}

Abgrall, Sophie ^{[12
,13
,14
]}

Guest, Jodie ^{[15
]}

Samji, Hasina ^{[16
]}

Monforte, Antonella D'Arminio ^{[17
]}

Llibre, Josep M. ^{[18
,19
]}

Smith, Colette ^{[20
]}

Cavassini, Matthias ^{[21
,22
]}

Burkholder, Greer A. ^{[23
]}

Shepherd, Bryan ^{[24
]}

Crane, Heidi M. ^{[25
]}

Sterne, Jonathan ^{[4
]}

Morlat, Philippe ^{[1
,2
,3
]}

机构：

[1] Univ Bordeaux Segalen, CHU Bordeaux, ISPED, INSERM,U897, F-33000 Bordeaux, France

[2] Univ Bordeaux Segalen, CHU Bordeaux, ISPED, CIC EC7, F-33000 Bordeaux, France

[3] CHU Bordeaux, Serv Med Interne & Malad Infect, F-33000 Bordeaux, France

[4] Univ Bristol, Sch Social & Community Med, Bristol, Avon, England

[5] Med Univ Innsbruck, Dept Dermatol & Venerol, A-6020 Innsbruck, Austria

[6] Stichting HIV Monitoring, Amsterdam, Netherlands

[7] Univ Calgary, Div Infect Dis, Calgary, AB, Canada

[8] Univ Hosp Bonn, Dept Internal Med 1, Bonn, Germany

[9] Hosp Ramon & Cajal, E-28034 Madrid, Spain

[10] Copenhagen Univ Hosp, Dept Infect Dis, Copenhagen, Denmark

[11] Univ Copenhagen, Panum Inst, Copenhagen HIV Programme, DK-1168 Copenhagen, Denmark

[12] Univ Paris 06, UMR S 943, F-75013 Paris, France

[13] INSERM, UMR S 943, F-75013 Paris, France

[14] Hop Avicenne, AP HP, Serv Malad Infect & Trop, F-93000 Bobigny, France

[15] Atlanta Vet Affairs Med Ctr, HIV Atlanta VA Cohort Study HAVACS, Decatur, GA USA

[16] British Columbia Ctr Excellence HIV AIDS, Div Epidemiol & Populat Hlth, Vancouver, BC, Canada

[17] Univ Milan, San Paolo Hosp, Clin Infect Dis & Trop Med, I-20122 Milan, Italy

[18] Univ Hosp Germans Trias & Pujol, Badalona, Spain

[19] Lluita SIDA Fdn, Badalona, Spain

[20] UCL, Res Dept Infect & Populat Hlth, London, England

[21] Univ Lausanne Hosp, Infect Dis Serv, Lausanne, Switzerland

[22] Univ Lausanne, Lausanne, Switzerland

[23] Univ Alabama Birmingham, Dept Med, Div Infect Dis, Birmingham, AL 35294 USA

[24] Vanderbilt Univ, Sch Med, Dept Biostat, Nashville, TN 37212 USA

[25] Univ Washington, Ctr AIDS Res, Seattle, WA 98195 USA

来源：

AIDS | 2015年 / 29卷 / 03期

基金：

英国医学研究理事会; 瑞士国家科学基金会; 美国国家卫生研究院; 加拿大健康研究院;

关键词：

AIDS event; death; HIV; low-level viremia; virological failure; ACTIVE ANTIRETROVIRAL THERAPY; HIV-INFECTED ADULTS; DRUG-RESISTANCE; VIRAL LOAD; INTERMITTENT; INFLAMMATION; MORTALITY; FAILURE; COHORT; CONSEQUENCES;

D O I：

10.1097/QAD.0000000000000544

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: The goal of antiretroviral therapy (ART) is to reduce HIV-related morbidity and mortality by suppressing HIV replication. The prognostic value of persistent low-level viremia (LLV), particularly for clinical outcomes, is unknown. Objective: Assess the association of different levels of LLV with virological failure, AIDS event, and death among HIV-infected patients receiving combination ART. Methods: We analyzed data from 18 cohorts in Europe and North America, contributing to the ART Cohort Collaboration. Eligible patients achieved viral load below 50 copies/ml within 3-9 months after ART initiation. LLV50-199 was defined as two consecutive viral loads between 50 and 199 copies/ml and LLV200-499 as two consecutive viral loads between 50 and 499 copies/ml, with at least one between 200 and 499 copies/ml. We used Cox models to estimate the association of LLV with virological failure (two consecutive viral loads at least 500 copies/ml or one viral load at least 500 copies/ml, followed by a modification of ART) and AIDS event/death. Results: Among 17 902 patients, 624 (3.5%) experienced LLV50-199 and 482 (2.7%) LLV200-499. Median follow-up was 2.3 and 3.1 years for virological and clinical outcomes, respectively. There were 1903 virological failure, 532 AIDS events and 480 deaths. LLV200-499 was strongly associated with virological failure [adjusted hazard ratio (aHR) 3.97, 95% confidence interval (CI) 3.05-5.17]. LLV50-199 was weakly associated with virological failure (aHR 1.38, 95% CI 0.96-2.00). LLV50-199 and LLV200-499 were not associated with AIDS event/death (aHR 1.19, 95% CI 0.78-1.82; and aHR 1.11, 95% CI 0.72-1.71, respectively). Conclusion: LLV200-499 was strongly associated with virological failure, but not with AIDS event/death. Our results support the US guidelines, which define virological failure as a confirmed viral load above 200 copies/ml. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.

引用

页码：373 / 383

页数：11

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