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Virological failure and all-cause mortality in HIV-positive adults with low-level viremia during antiretroviral treatment

Elvstam, Olof LU orcid ; Medstrand, Patrik LU orcid ; Yilmaz, Aylin ; Isberg, Per Erik LU ; Gisslen, Magnus and Bjorkman, Per LU orcid (2017) In PLoS ONE 12(7).
Abstract

Although most HIV-infected individuals achieve undetectable viremia during antiretroviral therapy (ART), a subset have low-level viremia (LLV) of varying duration and magnitude. The impact of LLV on treatment outcomes is unclear. We investigated the association between LLV and virological failure and/or all-cause mortality among Swedish patients receiving ART. Methods HIV-infected patients from two Swedish HIV centers were identified from the nationwide register InfCare HIV. Subjects aged ≤15 years with triple agent ART were included at 12 months after treatment initiation if ≤2 following viral load measurements were available. Patients with 2 consecutive HIV RNA values ≤1000 copies/mL at this time point were excluded. Participants were... (More)

Although most HIV-infected individuals achieve undetectable viremia during antiretroviral therapy (ART), a subset have low-level viremia (LLV) of varying duration and magnitude. The impact of LLV on treatment outcomes is unclear. We investigated the association between LLV and virological failure and/or all-cause mortality among Swedish patients receiving ART. Methods HIV-infected patients from two Swedish HIV centers were identified from the nationwide register InfCare HIV. Subjects aged ≤15 years with triple agent ART were included at 12 months after treatment initiation if ≤2 following viral load measurements were available. Patients with 2 consecutive HIV RNA values ≤1000 copies/mL at this time point were excluded. Participants were stratified into four categories depending on viremia profiles: permanently suppressed viremia (<50 copies/mL), LLV 50-199 copies/mL, LLV 200-999 copies/ mL and viremia ≤1000 copies/mL. Association between all four viremia categories and all-cause death was calculated using survival analysis with viremia as a time-varying covariate, so that patients could change viremia category during follow-up. Association between the three lower categories and virological failure (≤2 consecutive measurements ≤1000 copies/mL) was calculated in a similar manner. Results LLV 50-199 copies/mL was recorded in 70/1015 patients (6.9%) and LLV 200-999 copies/ mL in 89 (8.8%) during 7812 person-years of follow-up (median 6.5 years). LLV 200-999 copies/mL was associated with virological failure (adjusted hazard ratio 3.14 [95% confidence interval 1.41-7.03, p<0.01]), whereas LLV 50-199 copies/mL was not (1.01 [0.34-4.31, p = 0.99]; median follow-up 4.5 years). LLV 200-999 copies/mL had an adjusted mortality hazard ratio of 2.29 (0.98-5.32, p = 0.05) and LLV 50-199 copies/mL of 2.19 (0.90-5.37, p = 0.09). Conclusions In this Swedish cohort followed during ART for a median of 4.5 years, LLV 200-999 copies/ mL was independently associated with virological failure. Patients with LLV had higher rates of all-cause mortality, although not statistically significant in multivariate analysis.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
PLoS ONE
volume
12
issue
7
article number
e0180761
publisher
Public Library of Science (PLoS)
external identifiers
  • scopus:85022067151
  • pmid:28683128
  • wos:000405335200066
ISSN
1932-6203
DOI
10.1371/journal.pone.0180761
project
Low-level viremia in people living with HIV receiving antiretroviral treatment
language
English
LU publication?
yes
id
f21ea8db-a706-4f81-9b47-f40dd3ee8b0b
date added to LUP
2017-07-25 14:49:48
date last changed
2024-04-14 15:32:56
@article{f21ea8db-a706-4f81-9b47-f40dd3ee8b0b,
  abstract     = {{<p>Although most HIV-infected individuals achieve undetectable viremia during antiretroviral therapy (ART), a subset have low-level viremia (LLV) of varying duration and magnitude. The impact of LLV on treatment outcomes is unclear. We investigated the association between LLV and virological failure and/or all-cause mortality among Swedish patients receiving ART. Methods HIV-infected patients from two Swedish HIV centers were identified from the nationwide register InfCare HIV. Subjects aged ≤15 years with triple agent ART were included at 12 months after treatment initiation if ≤2 following viral load measurements were available. Patients with 2 consecutive HIV RNA values ≤1000 copies/mL at this time point were excluded. Participants were stratified into four categories depending on viremia profiles: permanently suppressed viremia (&lt;50 copies/mL), LLV 50-199 copies/mL, LLV 200-999 copies/ mL and viremia ≤1000 copies/mL. Association between all four viremia categories and all-cause death was calculated using survival analysis with viremia as a time-varying covariate, so that patients could change viremia category during follow-up. Association between the three lower categories and virological failure (≤2 consecutive measurements ≤1000 copies/mL) was calculated in a similar manner. Results LLV 50-199 copies/mL was recorded in 70/1015 patients (6.9%) and LLV 200-999 copies/ mL in 89 (8.8%) during 7812 person-years of follow-up (median 6.5 years). LLV 200-999 copies/mL was associated with virological failure (adjusted hazard ratio 3.14 [95% confidence interval 1.41-7.03, p&lt;0.01]), whereas LLV 50-199 copies/mL was not (1.01 [0.34-4.31, p = 0.99]; median follow-up 4.5 years). LLV 200-999 copies/mL had an adjusted mortality hazard ratio of 2.29 (0.98-5.32, p = 0.05) and LLV 50-199 copies/mL of 2.19 (0.90-5.37, p = 0.09). Conclusions In this Swedish cohort followed during ART for a median of 4.5 years, LLV 200-999 copies/ mL was independently associated with virological failure. Patients with LLV had higher rates of all-cause mortality, although not statistically significant in multivariate analysis.</p>}},
  author       = {{Elvstam, Olof and Medstrand, Patrik and Yilmaz, Aylin and Isberg, Per Erik and Gisslen, Magnus and Bjorkman, Per}},
  issn         = {{1932-6203}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{7}},
  publisher    = {{Public Library of Science (PLoS)}},
  series       = {{PLoS ONE}},
  title        = {{Virological failure and all-cause mortality in HIV-positive adults with low-level viremia during antiretroviral treatment}},
  url          = {{http://dx.doi.org/10.1371/journal.pone.0180761}},
  doi          = {{10.1371/journal.pone.0180761}},
  volume       = {{12}},
  year         = {{2017}},
}