Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Virologic failure following low-level viremia and viral blips during antiretroviral therapy: results from a European multicenter cohort

Elvstam, Olof LU orcid ; Malmborn, Kasper ; Elén, Sixten LU orcid ; Marrone, Gaetano LU ; Garcia, Federico ; Zazzi, Maurizio ; Sönnerborg, Anders ; Böhm, Michael ; Seguin-Devaux, Carole and Björkman, Per LU orcid (2023) In Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 76(1). p.25-31
Abstract

BACKGROUND: It is unclear whether low-level viremia (LLV), defined as repeatedly detectable viral load (VL) of <200 copies/mL, and/or transient viremic episodes (blips) during antiretroviral therapy (ART), predict future virologic failure. We investigated the association between LLV, blips, and virologic failure (VF) in a multi-center European cohort.

METHODS: People with HIV-1 who started ART 2005 or later were identified from the EuResist Integrated Database. We analyzed the incidence of VF (≥200 copies/mL) depending on viremia exposure, starting 12 months after ART initiation (grouped as suppression [≤50 copies/mL], blips [isolated VL of 51-999 copies/mL], and LLV [repeated VLs of 51-199 copies/mL]) using Cox proportional... (More)

BACKGROUND: It is unclear whether low-level viremia (LLV), defined as repeatedly detectable viral load (VL) of <200 copies/mL, and/or transient viremic episodes (blips) during antiretroviral therapy (ART), predict future virologic failure. We investigated the association between LLV, blips, and virologic failure (VF) in a multi-center European cohort.

METHODS: People with HIV-1 who started ART 2005 or later were identified from the EuResist Integrated Database. We analyzed the incidence of VF (≥200 copies/mL) depending on viremia exposure, starting 12 months after ART initiation (grouped as suppression [≤50 copies/mL], blips [isolated VL of 51-999 copies/mL], and LLV [repeated VLs of 51-199 copies/mL]) using Cox proportional hazard models adjusted for age, sex, injecting drug use, pre-ART VL, CD4 count, HIV-1 subtype, type of ART, and treatment experience. We queried the database for drug resistance mutations (DRM) related to episodes of LLV and VF and compared those with baseline resistance data.

RESULTS: During 81,837 person-years of follow-up, we observed 1,424 events of VF in 22,523 participants. Both blips (adjusted subhazard ratio [aHR], 1.7; 95% confidence interval [CI], 1.3-2.2) and LLV (aHR, 2.2; 95% CI, 1.6-3.0) were associated with VF, compared with virologic suppression. These associations remained statistically significant in sub-analyses restricted to people with VL <200 copies/mL and those starting ART 2014 or later. Among people with LLV and genotype data available within 90 days following LLV, 49/140 (35%) had at least one DRM.

CONCLUSIONS: Both blips and LLV during ART are associated with increased risk of subsequent VF.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
volume
76
issue
1
pages
25 - 31
publisher
Oxford University Press
external identifiers
  • scopus:85147275209
  • pmid:36100984
ISSN
1537-6591
DOI
10.1093/cid/ciac762
language
English
LU publication?
yes
id
599b0a10-0704-49b1-a3e7-03dbafa58c06
date added to LUP
2022-09-18 17:26:27
date last changed
2025-11-17 00:18:52
@article{599b0a10-0704-49b1-a3e7-03dbafa58c06,
  abstract     = {{<p>BACKGROUND: It is unclear whether low-level viremia (LLV), defined as repeatedly detectable viral load (VL) of &lt;200 copies/mL, and/or transient viremic episodes (blips) during antiretroviral therapy (ART), predict future virologic failure. We investigated the association between LLV, blips, and virologic failure (VF) in a multi-center European cohort.</p><p>METHODS: People with HIV-1 who started ART 2005 or later were identified from the EuResist Integrated Database. We analyzed the incidence of VF (≥200 copies/mL) depending on viremia exposure, starting 12 months after ART initiation (grouped as suppression [≤50 copies/mL], blips [isolated VL of 51-999 copies/mL], and LLV [repeated VLs of 51-199 copies/mL]) using Cox proportional hazard models adjusted for age, sex, injecting drug use, pre-ART VL, CD4 count, HIV-1 subtype, type of ART, and treatment experience. We queried the database for drug resistance mutations (DRM) related to episodes of LLV and VF and compared those with baseline resistance data.</p><p>RESULTS: During 81,837 person-years of follow-up, we observed 1,424 events of VF in 22,523 participants. Both blips (adjusted subhazard ratio [aHR], 1.7; 95% confidence interval [CI], 1.3-2.2) and LLV (aHR, 2.2; 95% CI, 1.6-3.0) were associated with VF, compared with virologic suppression. These associations remained statistically significant in sub-analyses restricted to people with VL &lt;200 copies/mL and those starting ART 2014 or later. Among people with LLV and genotype data available within 90 days following LLV, 49/140 (35%) had at least one DRM.</p><p>CONCLUSIONS: Both blips and LLV during ART are associated with increased risk of subsequent VF.</p>}},
  author       = {{Elvstam, Olof and Malmborn, Kasper and Elén, Sixten and Marrone, Gaetano and Garcia, Federico and Zazzi, Maurizio and Sönnerborg, Anders and Böhm, Michael and Seguin-Devaux, Carole and Björkman, Per}},
  issn         = {{1537-6591}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{1}},
  pages        = {{25--31}},
  publisher    = {{Oxford University Press}},
  series       = {{Clinical infectious diseases : an official publication of the Infectious Diseases Society of America}},
  title        = {{Virologic failure following low-level viremia and viral blips during antiretroviral therapy: results from a European multicenter cohort}},
  url          = {{http://dx.doi.org/10.1093/cid/ciac762}},
  doi          = {{10.1093/cid/ciac762}},
  volume       = {{76}},
  year         = {{2023}},
}