Abstract
The introduction of antiretroviral therapy (ART) has allowed human immunodeficiency virus (HIV) suppression in patients. We present data of a cohort of Puerto Rican patients with HIV who were under treatment with a steady regime of ART across a time horizon of eleven years. The time periods were categorized into four year stratums: 2000 to 2002; 2003 to 2005; 2006 to 2008 and 2009 to 2011. Socio-demographic profile, HIV risk factors, co-morbid conditions were included as study variables. One year mortality was defined. The p value was set at ≤0.05. The cohort consisted of 882 patients with 661 subjects presenting with persistent HIV viral load after a self-reported 12 month history of ART use. In this sub-cohort a higher viral load was seen across time (p < 0.05). Illicit drug use, IV drug use, alcohol use, loss of work were associated to having higher viral load means (p < 0.05). HIV viral load mean was lower as BMI increased (p < 0.001). It is imperative to readdress antiretroviral adherence protocols and further study ART tolerance and compliance.
Highlights
In the absence of antiretroviral therapy (ART), human immunodeficiency virus (HIV-1) infection causes a longitudinal decline in the CD4 helper T cells with deterioration of the immune system.The lack of effective immunological response increases vulnerability to multiple opportunistic infections [1,2,3,4]
We have compared the group according to presence or absence of detectable HIV viral load and have analyzed the profile of subjects with detectable viral load according to sociodemographic variables, HIV risk factors, presence of comorbid clinical conditions, psychological profile and one year mortality
Evaluating the mediating and possibly synergistic effects of concurrent high risk practices with persistently detectable HIV viral load is a complex endeavor, our group and others have implicated that IV drug use as a significant factor associated to virological failure in subjects with persistent ART use
Summary
In the absence of antiretroviral therapy (ART), human immunodeficiency virus (HIV-1) infection causes a longitudinal decline in the CD4 helper T cells with deterioration of the immune system. A major hurdle of the HIV epidemic is the sub-cohort of subjects who continue to have significant detectable viral load despite ART [8,9]. Laprise et al reported that persistent viral load between 50 and 999 copies/mL was associated to an increased risk of virologic failure [8]. We selected a cohort of subjects which were new to our ambulatory care clinic and had a one year history of stable ART use. We have compared the group according to presence or absence of detectable HIV viral load and have analyzed the profile of subjects with detectable viral load according to sociodemographic variables, HIV risk factors, presence of comorbid clinical conditions, psychological profile and one year mortality. Considering that protease inhibitors became widely available in the island in 1998 and that we were interested in defining the one year mortality, the time period selected was 1st January 2000 through 31th December 2011
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