Abstract
BackgroundIn human immunodeficiency virus treatment adequate virological suppression is warranted, nevertheless for some patients it remains a challenge. We investigated factors associated with low-level viraemia (LLV) and virological failure (VF) under combined antiretroviral therapy (cART).Materials and MethodsWe analysed patients receiving standard regimens between 1st July 2012 and 1st July 2013 with at least one viral load (VL) measurement below the quantification limit (BLQ) in their treatment history. After a minimum of 6 months of unmodified cART, the next single VL measurement within 6 months was analysed. VF was defined as HIV RNA levels ≥200 copies/mL and all other quantifiable measurements were classified as LLV. Factors associated with LLV and VF compared to BLQ were identified by logistic regression models.ResultsOf 2276 participants, 1972 (86.6%) were BLQ, 222 (9.8%) showed LLV and 82 (3.6%) had VF. A higher risk for LLV and VF was shown in patients with cART interruptions and in patients with boosted PI therapy. The risk for LLV and VF was lower in patients from centres using the Abbott compared to the Roche assay to measure VL. A higher risk for LLV but not for VF was found in patients with a higher VL before cART [for >99.999 copies/mL: aOR (95% CI): 4.19 (2.07–8.49); for 10.000–99.999 copies/mL: aOR (95% CI): 2.52 (1.23–5.19)] and shorter cART duration [for <9 months: aOR (95% CI): 2.59 (1.38–4.86)]. A higher risk for VF but not for LLV was found in younger patients [for <30 years: aOR (95% CI): 2.76 (1.03–7.35); for 30–50 years: aOR (95% CI): 2.70 (1.26–5.79)], people originating from high prevalence countries [aOR (95% CI): 2.20 (1.09–4.42)] and in male injecting drug users [aOR (95% CI): 2.72 (1.38–5.34)].ConclusionsFor both VF and LLV, factors associated with adherence play a prominent role. Furthermore, performance characteristics of the diagnostic assay used for VL quantification should also be taken into consideration.
Highlights
The advent of combined antiretroviral therapy resulted in a significant reduction in morbidity and mortality for persons infected with the human immunodeficiency virus type 1 (HIV-1) [1,2]
A higher risk for level viraemia (LLV) and virological failure (VF) was shown in patients with combined antiretroviral therapy (cART) interruptions and in patients with boosted protease inhibitor (PI) therapy
The risk for LLV and VF was lower in patients from centres using the Abbott compared to the Roche assay to measure viral load (VL)
Summary
The advent of combined antiretroviral therapy (cART) resulted in a significant reduction in morbidity and mortality for persons infected with the human immunodeficiency virus type 1 (HIV-1) [1,2]. The threshold for virological failure (VF) remains controversial ranging from 50 to 200 copies/ mL [3,4]. These discrepancies reflect the fact that optimal virological suppression remains often an ideal goal but some patients may show persistent low-level viraemia (LLV) and the best clinical practice in such cases, especially concerning LLV between 20–200 copies/mL, is not resolved. In human immunodeficiency virus treatment adequate virological suppression is warranted, for some patients it remains a challenge. We investigated factors associated with low-level viraemia (LLV) and virological failure (VF) under combined antiretroviral therapy (cART)
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