Viral blips during suppressive antiretroviral treatment are associated with high baseline HIV-1 RNA levels


Background:
Many HIV-1-infected patients on suppressive antiretroviral therapy (ART) have transiently elevated HIV RNA levels. The clinical significance of these viral blips is uncertain. We have determined the incidence of blips and investigated important associations in the Swedish HIV-cohort.

Methods:
HIV-1-infected ART naïve adults who commenced ART 2007–2013 were retrospectively included. Viral blips were defined as a transient viral load between 50 and 500 copies/mL Subjects not suppressed after six months on ART were excluded.

Results:
Viral blips were found in 76/735 included subjects (10.3 %) and in 90/4449 samples (2.0 %). Median blip viral load was 76 copies/mL (range 56–138). Median follow-up time was 170 weeks (range 97–240). Baseline viral load was higher in subjects with viral blips (median log10 4.85 copies/mL) compared with subjects without blips (median log10 4.55 copies/mL) (p < 0.01). There was a significant association between viral blips and risk for subsequent virological failure (p < 0.001).

Conclusions:
The Swedish national HIV-cohort has a low incidence of viral blips (10 %). Blips were associated with high baseline viral load and an increased risk of subsequent virological failure.

Keywords:
Viral blip, Transient viremia, HIV-1, Antiretroviral therapy


Autoři: Erik Sörstedt 1*;  Staffan Nilsson 2;  Anders Blaxhult 3;  Magnus Gisslén 1;  Leo Flamholc 4;  Anders Sönnerborg 5,6;  Aylin Yilmaz 1
Působiště autorů: Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 41 90 Gothenburg, Sweden. 1;  Department of Mathematical Sciences, Chalmers University of Technology, 12 8 Gothenburg, Sweden. 2;  Department of Infectious Diseases, Venhälsan-Södersjukhuset, 118 83 Stockholm, Sweden. 3;  Department of Infectious Diseases, Malmö University Hospital, 20 02 Malmö, Sweden. 4;  Department of Infectious Diseases, Karolinska Institute, Karolinska University Hospital, 141 8 Stockholm, Sweden. 5;  Department of Clinical Microbiology, Karolinska Institute, Karolinska University Hospital, 141 86 Stockholm, Sweden. 6
Vyšlo v časopise: BMC Infectious diseases 2016, 16:305
Kategorie: Research article
prolekare.web.journal.doi_sk: 10.1186/s12879-016-1628-6

© 2016 The Author(s).
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The electronic version of this article is the complete one and can be found online at: http://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-016-1628-6

Souhrn

Background:
Many HIV-1-infected patients on suppressive antiretroviral therapy (ART) have transiently elevated HIV RNA levels. The clinical significance of these viral blips is uncertain. We have determined the incidence of blips and investigated important associations in the Swedish HIV-cohort.

Methods:
HIV-1-infected ART naïve adults who commenced ART 2007–2013 were retrospectively included. Viral blips were defined as a transient viral load between 50 and 500 copies/mL Subjects not suppressed after six months on ART were excluded.

Results:
Viral blips were found in 76/735 included subjects (10.3 %) and in 90/4449 samples (2.0 %). Median blip viral load was 76 copies/mL (range 56–138). Median follow-up time was 170 weeks (range 97–240). Baseline viral load was higher in subjects with viral blips (median log10 4.85 copies/mL) compared with subjects without blips (median log10 4.55 copies/mL) (p < 0.01). There was a significant association between viral blips and risk for subsequent virological failure (p < 0.001).

Conclusions:
The Swedish national HIV-cohort has a low incidence of viral blips (10 %). Blips were associated with high baseline viral load and an increased risk of subsequent virological failure.

Keywords:
Viral blip, Transient viremia, HIV-1, Antiretroviral therapy


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