Virologic failure following low-level viremia and viral blips during antiretroviral therapy: results from a European multicenter cohort
(2023) In Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 76(1).- 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.
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- author
- Elvstam, Olof LU ; Malmborn, Kasper ; Elén, Sixten ; Marrone, Gaetano LU ; Garcia, Federico ; Zazzi, Maurizio ; Sönnerborg, Anders ; Böhm, Michael ; Seguin-Devaux, Carole and Björkman, Per LU
- organization
- publishing date
- 2023-01-01
- 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
- publisher
- Oxford University Press
- external identifiers
-
- pmid:36100984
- scopus:85147275209
- ISSN
- 1537-6591
- DOI
- 10.1093/cid/ciac762
- language
- English
- LU publication?
- yes
- additional info
- © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
- id
- 599b0a10-0704-49b1-a3e7-03dbafa58c06
- date added to LUP
- 2022-09-18 17:26:27
- date last changed
- 2024-06-15 00:58:42
@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 <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 <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}}, 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}}, }