1
|
Oomen PGA, Dijkstra S, Hofstra LM, Nijhuis MM, Verbon A, Mudrikova T, Wensing AMJ, Hoepelman AIM, Van Welzen BJ. Integrated analysis of viral blips, residual viremia, and associated factors in people with HIV: Results from a retrospective cohort study. J Med Virol 2023; 95:e29178. [PMID: 37861450 DOI: 10.1002/jmv.29178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/07/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023]
Abstract
The etiology of viral blips is not yet fully elucidated. One of the hypotheses is that blips reflect variations in residual viremia (RV) near the detectability threshold. In this study, we evaluated whether RV is associated with viral blips and which factors are associated with RV. All treatment regimens in 2010-2020 consisting of two nucleos(-t)ide reverse transcriptase inhibitors and one anchor (integrase strand transfer inhibitor [INSTI], non-nucleoside reverse transcriptase inhibitor [NNRTI], or protease inhibitor [PI]) in people with HIV (PWH) were evaluated for RV (detectable viremia <50 cp/mL) and blips (isolated viral loads [VLs] 50-499 cp/mL between measurements <50 cp/mL). All medical records were reviewed and regimens in which a VL ≥ 50 cp/mL was deemed to result from non-adherence (based on the documented conclusion by the treating physician) were excluded. Factors associated with blips and RV were identified using generalized linear mixed models. In total, 24 518 VLs from 1658 PWH were analyzed. VLs were measured during INSTI- (n = 5119; 20.9%), PI- (n = 8935; 36.4%), and NNRTI-use (n = 10 464; 42.7%). VLs were categorized as blips in 1.4% (n = 332). The 24,186 non-blip VLs were RNAneg (no RV) (n = 15 326; 63.4%), 1-19 cp/mL (n = 6318; 26.1%), 20-49 cp/mL (n = 1620; 6.7%), or <50 cp/mL with an unknown RV level (n = 922; 3.8%). In 193/1658 PWH (11.6%), the RV level was RNAneg in all VLs assessed. RV 1-19 cp/mL and 20-49 cp/mL (vs. RNAneg ) were significantly associated with subsequent viral blips (respective odds ratio 2.66 and 4.90 [95% confidence intervals: 1.98-3.58 and 3.41-7.04]). Zenith VL and use of PIs (vs. INSTIs/NNRTIs) were associated with higher RV and blip odds. This large cohort study showed that blips were associated with higher preceding RV. Both the anchor type and factors previously linked to the latent viral reservoir were associated with RV, suggesting blips having a multifactorial origin.
Collapse
Affiliation(s)
- Patrick G A Oomen
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Suzan Dijkstra
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Marije Hofstra
- Department of Medical Microbiology, Translational Virology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Monique M Nijhuis
- Department of Medical Microbiology, Translational Virology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annelies Verbon
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tania Mudrikova
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annemarie M J Wensing
- Department of Medical Microbiology, Translational Virology, University Medical Center Utrecht, Utrecht, The Netherlands
- Ezintsha, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andy I M Hoepelman
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Berend J Van Welzen
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
2
|
Risk of HIV viral rebound in HIV infected patients on direct acting antivirals (DAAs) treatment for HCV. PLoS One 2022; 17:e0262917. [PMID: 35113890 PMCID: PMC8812874 DOI: 10.1371/journal.pone.0262917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/07/2022] [Indexed: 12/27/2022] Open
Abstract
Background The dynamic of HIV-viral load (VL) remains poorly investigated in HIV/HCV patients under direct acting antivirals (DAAs). Methods We retrospectively evaluated HIV-VL at baseline (BL) during and up to 24 weeks post-DAAs in a cohort of 305 HIV-1/HCV patients, on ART and with no HIV virological failure (VF) in the 6 months before treatment with DAAs; during the period of observation VF was defined as confirmed VL≥50 copies/mL; virological blips (VB, transient, not confirmed, VL ≥50 copies/mL). Stepwise Cox regression models were fitted to estimate adjusted hazard ratios (aHR) of VF. Results Fifteen VF occurred in 13 patients over 187 person-years of follow-up (PYFU): incidence rate (IR) of 8.0 per 100-PYFU (95% CI = 4.0–12.1); 29 VBs were detected in 26 patients over 184 PYFU: IR = 15.8 per 100-PYFU (95% CI = 10.0–21.5). The most prominent factor associated with VF was the presence of BL HIV residual viremia (RV = HIV-RNA detectable but not precisely quantifiable) [aHR = 12.26 (95% CI = 3.74–40.17), P<0.0001]. Other factors were ≥1 VBs in the 6 months before DAAs [aHR = 6.95 (95% CI = 1.77–27.37) P = 0.006] number of ART regimens failed before DAAs initiation [aHR (per more regimen) = 1.22 (95% CI = 1.04–1.42), P = 0.012] and age [aHR (per year older) = 1.16 (95% CI = 1.04–1.29), P = 0.010]. Conclusions Our findings underline the importance for close monitoring HIV-VL in selected patients. Whether this phenomenon is triggered by the rapid clearance of HCV remains to be established.
Collapse
|
3
|
Gianotti N, Galli L, Poli A, Torre LD, Vinci C, Carini E, Galli A, Nozza S, Spagnuolo V, Muccini C, Lazzarin A, Castagna A. Residual viremia in HIV-infected patients who continue a two-drug or switch to a three-drug integrase strand transfer inhibitor based regimen. AIDS 2021; 35:1513-1516. [PMID: 33831909 DOI: 10.1097/qad.0000000000002908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In this randomized, single-centre, open-label, 96-week, superiority, controlled trial of 50 HIV-infected patients with HIV-RNA less than 50 copies/ml on a two-drug regimen based on dolutegravir as well as one reverse transcriptase inhibitor (RTI), switching to a single-tablet regimen of cobicistat, elvitregravir, emtricitabine along with tenofovir alafenamide did not appear to mitigate the burden of residual viremia, both at week 48 and at week 96. The immunological changes observed during follow-up and the safety of the two regimens were similar.
Collapse
Affiliation(s)
- Nicola Gianotti
- Infectious Diseases, IRCCS San Raffaele Scientific Institute
| | - Laura Galli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute
| | - Andrea Poli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute
| | | | - Concetta Vinci
- Infectious Diseases, IRCCS San Raffaele Scientific Institute
| | | | - Andrea Galli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute
| | - Silvia Nozza
- Infectious Diseases, IRCCS San Raffaele Scientific Institute
| | - Vincenzo Spagnuolo
- Infectious Diseases, IRCCS San Raffaele Scientific Institute
- Vita-Salute San Raffaele University, Milan, Italy
| | - Camilla Muccini
- Infectious Diseases, IRCCS San Raffaele Scientific Institute
| | | | - Antonella Castagna
- Infectious Diseases, IRCCS San Raffaele Scientific Institute
- Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
4
|
Zuo L, Peng K, Hu Y, Xu Q. Genotypic Methods for HIV Drug Resistance Monitoring: The Opportunities and Challenges Faced by China. Curr HIV Res 2020; 17:225-239. [PMID: 31560290 DOI: 10.2174/1570162x17666190927154110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/05/2019] [Accepted: 09/20/2019] [Indexed: 12/18/2022]
Abstract
AIDS is a globalized infectious disease. In 2014, UNAIDS launched a global project of "90-90-90" to end the HIV epidemic by 2030. The second and third 90 require 90% of HIV-1 infected individuals receiving antiretroviral therapy (ART) and durable virological suppression. However, wide use of ART will greatly increase the emergence and spreading of HIV drug resistance and current HIV drug resistance test (DRT) assays in China are seriously lagging behind, hindering to achieve virological suppression. Therefore, recommending an appropriate HIV DRT method is critical for HIV routine surveillance and prevention in China. In this review, we summarized the current existing HIV drug resistance genotypic testing methods around the world and discussed the advantages and disadvantages of these methods.
Collapse
Affiliation(s)
- Lulu Zuo
- Institute of Life Sciences, Jiangsu University, Zhenjiang, Jiangsu 212002, China.,Pathogen Discovery & Big Data Center, CAS Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences; Shanghai 200031, China
| | - Ke Peng
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, China
| | - Yihong Hu
- Pathogen Discovery & Big Data Center, CAS Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences; Shanghai 200031, China
| | - Qinggang Xu
- Institute of Life Sciences, Jiangsu University, Zhenjiang, Jiangsu 212002, China
| |
Collapse
|
5
|
Pascom AR, Pinho RE, Rick F, Veras NM, Perini FDB, Meireles MV, Pereira GF, Benzaken AS, Avelino-Silva VI. Comparison of cumulative viraemia following treatment initiation with different antiretroviral regimens: a real-life study in Brazil. J Int AIDS Soc 2020; 22:e25397. [PMID: 31743620 PMCID: PMC6863473 DOI: 10.1002/jia2.25397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 09/03/2019] [Indexed: 11/27/2022] Open
Abstract
Introduction The relative efficacy of different antiretroviral (ART) regimens has been extensively evaluated in the context of clinical trials, using HIV viral load (VL) measurements at pre‐specified timepoints after ART onset. However, data from real‐life studies using combined longitudinal measurements of cumulative viraemia are scarce. This study aimed to address the independent effect of different ART regimens on HIV cumulative viraemia over the first 12 months after treatment initiation, using programmatic data from the Ministry of Health of Brazil. Methods Retrospective cohort study analysing cumulative viraemia under the most frequently used ART regimens in Brazil (tenofovir, lamivudine and dolutegravir (regimen 1); tenofovir, lamivudine and efavirenz (regimen 2); tenofovir, lamivudine and ritonavir‐boosted atazanavir (regimen 3)). Results and Discussion We included 112,243 patients >12 years old who received their first ART prescription between January 2014 and August 2017. Univariate analysis indicated that cumulative viraemia was significantly lower in patients receiving regimen 1 as compared with those receiving regimens 2 or 3 (p<0.0001 for both pairwise comparisons). In a multivariable analysis adjusted for age, sex, baseline T CD4+ counts and baseline HIV VL, ART regimen persisted with statistically significant effect on 12‐month cumulative viraemia. The model predicted a 45‐unit increase in log10 copy‐days/mL cumulative viraemia for regimen 2 as compared with regimen 1, and a 70‐unit increase in log10 copy‐days/mL cumulative viraemia for regimen 3 as compared with regimen 1 (95%CI 41 to 49 and 61 to 79 respectively; p<0.001 for both comparisons). In models restricted to youths (13 to 24 years old) and female patients, ART regimen had similar effects. ART regimen with dolutegravir in association with a tenofovir‐lamivudine backbone was superior to regimens containing efavirenz or boosted atazanavir in reducing HIV VL, as shown by cumulative viraemia over the first 12 months after treatment initiation. The superiority persisted even after adjusting the analysis for potential confounders. Conclusions Our findings could bring direct benefits to patients as suggested by lower viral replication during treatment, lower risk of HIV transmission, and a potential reduction in resistance mutations in the initial 12 months under ART.
Collapse
Affiliation(s)
- Ana R Pascom
- Department of Surveillance, Prevention and Control of STIs, Ministry of Health of Brazil, HIV/AIDS and Viral Hepatitis, Brasilia, Brazil
| | - Rosana Egg Pinho
- Department of Surveillance, Prevention and Control of STIs, Ministry of Health of Brazil, HIV/AIDS and Viral Hepatitis, Brasilia, Brazil
| | - Fernanda Rick
- Department of Surveillance, Prevention and Control of STIs, Ministry of Health of Brazil, HIV/AIDS and Viral Hepatitis, Brasilia, Brazil
| | - Nazle Mc Veras
- Department of Surveillance, Prevention and Control of STIs, Ministry of Health of Brazil, HIV/AIDS and Viral Hepatitis, Brasilia, Brazil
| | - Filipe de Barros Perini
- Department of Surveillance, Prevention and Control of STIs, Ministry of Health of Brazil, HIV/AIDS and Viral Hepatitis, Brasilia, Brazil
| | - Mariana V Meireles
- Department of Surveillance, Prevention and Control of STIs, Ministry of Health of Brazil, HIV/AIDS and Viral Hepatitis, Brasilia, Brazil
| | - Gerson F Pereira
- Department of Surveillance, Prevention and Control of STIs, Ministry of Health of Brazil, HIV/AIDS and Viral Hepatitis, Brasilia, Brazil
| | - Adele S Benzaken
- Tropical Medicine Foundation Heitor Vieira Dourado, Manaus, Brazil
| | - Vivian I Avelino-Silva
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
6
|
Differences in HIV Markers between Infected Individuals Treated with Different ART Regimens: Implications for the Persistence of Viral Reservoirs. Viruses 2020; 12:v12050489. [PMID: 32349381 PMCID: PMC7290301 DOI: 10.3390/v12050489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/17/2022] Open
Abstract
In adherent individuals, antiretroviral therapy (ART) suppresses HIV replication, restores immune function, and prevents the development of AIDS. However, ART is not curative and has to be followed lifelong. Persistence of viral reservoirs forms the major obstacle to an HIV cure. HIV latent reservoirs persist primarily by cell longevity and proliferation, but replenishment by residual virus replication despite ART has been proposed as another potential mechanism of HIV persistence. It is a matter of debate whether different ART regimens are equally potent in suppressing HIV replication. Here, we summarized the current knowledge on the role of ART regimens in HIV persistence, focusing on differences in residual plasma viremia and other virological markers of the HIV reservoir between infected individuals treated with combination ART composed of different antiretroviral drug classes.
Collapse
|
7
|
Detectability of HIV Residual Viremia despite Therapy Is Highly Associated with Treatment with a Protease Inhibitor-Based Combination Antiretroviral Therapy. Antimicrob Agents Chemother 2020; 64:AAC.01902-19. [PMID: 31818822 DOI: 10.1128/aac.01902-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/05/2019] [Indexed: 01/05/2023] Open
Abstract
HIV persistence despite therapy contributes to chronic immune activation and inflammation, increasing the risk of aging-associated events in HIV-infected individuals. We sought here to better understand the complex link between clinical and treatment features and HIV persistence despite therapy. A total of 11,045 samples from 1,160 individuals under combination antiretroviral therapy (cART) with an unquantifiable viral load (VL; limit of quantification, 20 copies/ml) were categorized as detectable or undetectable depending on the detection of a PCR signal using a commercially available assay. Generalized estimating equation (GEE) regression was used to model viral load detectability and to assess the determinants of residual viremia (RV; VL detected below 20 copies/ml) despite therapy. A high VL zenith was associated with a higher probability to have a detectable viremia under cART. Conversely, the probability to have a detectable viral load below 20 copies/ml decreased with time under therapy. Of therapy regimens, protease inhibitor (PI)-based cART was associated with a significantly higher probability of detectable RV compared to nonnucleoside transcriptase inhibitor- or integrase inhibitor-based cART. We found that a PI-based treatment regimen is highly associated with an increased frequency of RV, supporting previous evidence suggesting that PI-based cART regimens could favor ongoing viral replication in some individuals.
Collapse
|
8
|
Galizzi N, Poli A, Galli L, Muccini C, Mastrangelo A, Dell'Acqua R, Maillard M, Bossolasco S, Cinque P, Lazzarin A, Castagna A, Gianotti N. Retrospective study on the outcome of two-drug regimens based on dolutegravir plus one reverse transcriptase inhibitor in virologically-suppressed HIV-infected patients. Int J Antimicrob Agents 2020; 55:105893. [PMID: 31926287 DOI: 10.1016/j.ijantimicag.2020.105893] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 11/09/2019] [Accepted: 12/28/2019] [Indexed: 11/18/2022]
Abstract
This was a retrospective study on the efficacy and drug resistance mutations selected at virological failure (VF) in prospectively-followed HIV-infected patients switched to dolutegravir plus rilpivirine (DTG+RPV) or lamivudine (DTG+3TC) while virologically suppressed (HIV-RNA <50 copies/mL). VF was defined as HIV-RNA >50 copies/mL in two consecutive determinations or in a single determination if followed by treatment modification, or >1000 copies/mL in a single determination. Totally, 374 patients were analysed (307 switched to DTG+3TC and 67 to DTG+RPV); 220 had documented historical resistance. The median (IQR) time with HIV-RNA <50 copies/mL before switch was 4.52 (1.93-8.14) years. VF occurred in 17 patients after a median of 1.74 (0.90-2.46) years of follow-up in the 3TC group [incidence rate (95% CI) 3.34 (2.08-5.37) per 100-PYFU] and in 2 patients after a median of 1.78 (1.10-2.99) years of follow-up in the RPV group [incidence rate (95% CI) 1.57 (0.4-6.28) per 100-PYFU]. The 48-week estimated probabilities to maintain virological suppression during treatment with a two-drug regimen were 97.8% (95% CI 95.1-99.0%) vs. 98.3% (95% CI 88.6-99.8%) in the 3TC versus RPV group (P = 0.311). At switch, patients with VF had undetectable HIV-RNA since 0.71 (0.23-1.07) years versus 1.49 (0.64-2.2) years in those without VF (P = 0.001). In the 3TC group, VF was not associated with the presence of historical resistance to nucleoside analogues, and DTG-resistant variants were not selected at VF. One VF to DTG+RPV occurred because of historical resistance to RPV, accompanied by newly selected G140A and Q148R mutations. VF was infrequent with these regimens and was negatively associated with duration of viral undetectability. Drug resistance mutations selected at failure of these regimens were those expected in case of failure of any regimen including DTG, 3TC or RPV, but the impact of resistance to NRTIs on efficacy of DTG+3TC seems lower than expected.
Collapse
Affiliation(s)
- Nadia Galizzi
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127 Milan, Italy
| | - Andrea Poli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127 Milan, Italy
| | - Laura Galli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127 Milan, Italy
| | - Camilla Muccini
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127 Milan, Italy; Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Andrea Mastrangelo
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127 Milan, Italy; Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Raffaele Dell'Acqua
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127 Milan, Italy; University Hospital Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Myriam Maillard
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127 Milan, Italy
| | - Simona Bossolasco
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127 Milan, Italy
| | - Paola Cinque
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127 Milan, Italy
| | - Adriano Lazzarin
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127 Milan, Italy
| | - Antonella Castagna
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127 Milan, Italy; Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Nicola Gianotti
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127 Milan, Italy.
| |
Collapse
|
9
|
How relevant is the HIV low level viremia and how is its management changing in the era of modern ART? A large cohort analysis. J Clin Virol 2019; 123:104255. [PMID: 31927152 DOI: 10.1016/j.jcv.2019.104255] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/03/2019] [Accepted: 12/21/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND It is still unclear what might be the best management of people living with HIV (PLWHIV) with low level viremia (LLV) despite being on antiretroviral treatment (ART). OBJECTIVES Aim of our study is to describe the clinical management of PLWHIV with LLV followed in a large cohort. STUDY DESIGN Retrospective cohort study. RESULTS We included 1607 adult patients over a three-year period (2015-2017). Follow up continued until June, 30th 2019 or last available visit. We observed a low incidence of LLV (0.9 % in 2015, 0.7 % in 2016 and 0.4 % in 2017), with a total of 21 patients with persistent LLV (pLLV), i.e. two consecutive HIV-RNA determinations of 50-500 copies/ml after at least 4 months of viral suppression. Among them, 12 had low compliance to treatment. Genotype resistance test (GRT) was performed in 14 patients and demonstrated at least one resistance mutation in 85.7 %. We described three categories of patients with pLLV: i) those whose ART regimen was not adequate based on GRT; ii) those with presumed suboptimal drug exposure, consequence of low adherence and/or drug-drug interactions and iii) those in which pLLV remained unexplained. For the first two categories, optimization or intensification of ART regimen led to viral suppression in >80 % of patients. We observed only 2 (9.5 %) virological failures and 1 (4.8 %) persistence of LLV in patients who did not switch ART. CONCLUSIONS In our cohort, the rate of LLV showed a decline in most recent years. Adherence and previous GRT should be carefully considered with the aim of further reducing the phenomenon.
Collapse
|
10
|
Lambert-Niclot S, Boyd A, Fofana D, Valin N, Wirden M, Meynard JL, Palich R, Agher R, Valantin MA, Calvez V, Katlama C, Girard PM, Marcelin AG, Morand-Joubert L. INSTI-Based Triple Regimens in Treatment-Naïve HIV-Infected Patients Are Associated With HIV-RNA Viral Load Suppression at Ultralow Levels. Open Forum Infect Dis 2019; 6:ofz177. [PMID: 31123690 PMCID: PMC6524833 DOI: 10.1093/ofid/ofz177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/08/2019] [Indexed: 12/22/2022] Open
Abstract
Background During antiretroviral therapy (ART), HIV-1-infected patients may present with ultralow (UL) HIV-RNA viral loads (VLs) below quantification levels of current assays. Reasons for UL-VL detection and its relation to virological rebound (VR) are unclear. Methods HIV-1-infected, ART-naïve patients followed at 2 university hospitals were included. All participants had an HIV-RNA >200 copies/mL at ART initiation and achieved a VL <50 copies/mL during ART. UL-VL was determined by the presence/absence of polymerase chain reaction signal detected using a commercially available assay (COBAS, TaqMan, Roche). Random-effects Poisson regression was used for assessing determinants of UL-VL not detected overtime and conditional risk set analysis for VR (1 VL > 200 copies/mL or 2 VL > 50 copies/mL) while accounting for frequency of VL measurements. Results Between 2009 and 2013, 717 patients initiated ART containing 2 nucleos(-t)ide reverse transcriptase inhibitors (NRTIs) plus a non-NRTI (29.4%), a protease inhibitor (58.4%), or an integrase-strand transfer inhibitor (INSTI; 12.1%). During a median (interquartile range) 3.4 (2.3–4.6) years, 676 (94.3%) patients achieved UL-VL not detected. In multivariable analysis, UL-VL not detected overtime was associated with younger age (P < .001), female gender (P = .04), lower baseline VL (P < .001), baseline CD4+ >500 vs <350/mm3 (P < .001), and INSTI-containing ART (P = .009). One hundred thirty-one (18.3%) patients had VR during follow-up, which was independently associated with a CD4/CD8 ratio <0.8 during follow-up (P = .01) and time spent with UL-VL not detected (P < .001). When UL-VL not detected occurred for ≥50% of the follow-up duration (n = 290), faster time to reach UL-VL not detected (P < .001), faster CD4+ T-cell count increase (P = .03), and faster CD4/CD8 ratio increase (P = .001) were observed. Conclusions VL suppression at an ultralow level is associated with INSTI-class ART initiation. Extensive VL suppression below ultralow detection could improve immune reconstitution.
Collapse
Affiliation(s)
- Sidonie Lambert-Niclot
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Saint-Antoine, Laboratoire de Virologie, Paris, France
| | - Anders Boyd
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France
| | - Djeneba Fofana
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Saint-Antoine, Laboratoire de Virologie, Paris, France
| | - Nadia Valin
- AP-HP, Hôpital Saint-Antoine, Département de Maladies Infectieuses, Paris, France
| | - Marc Wirden
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de Virologie, Paris, France
| | - Jean-Luc Meynard
- AP-HP, Hôpital Saint-Antoine, Département de Maladies Infectieuses, Paris, France
| | - Romain Palich
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Pitié Salpêtrière, Département de Maladies Infectieuses, Paris, France
| | - Rachid Agher
- AP-HP, Hôpital Pitié Salpêtrière, Département de Maladies Infectieuses, Paris, France
| | - Marc-Antoine Valantin
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Pitié Salpêtrière, Département de Maladies Infectieuses, Paris, France
| | - Vincent Calvez
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de Virologie, Paris, France
| | - Christine Katlama
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Pitié Salpêtrière, Département de Maladies Infectieuses, Paris, France
| | - Pierre-Marie Girard
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Saint-Antoine, Département de Maladies Infectieuses, Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de Virologie, Paris, France
| | - Laurence Morand-Joubert
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Saint-Antoine, Laboratoire de Virologie, Paris, France
| |
Collapse
|