20th International AIDS Conference - Melbourne, Australia

Abstract

TUAB0102 - Oral Abstract Session


Effect of viral suppression below 20 copies of HIV-RNA per millilitre of plasma on virological outcome of treated HIV-infected patients

Presented by Ramon Teira (Spain).

R. Teira1, P. Muñoz-Sanchez2, I. Suarez-Lozano3, E. Martinez4, A. Muñoz-Sanz5, B. de la Fuente6, M. Montero7, J. Borrallo8, T. Puig9, F. Vidal10, M. Castaño11, V. Estrada12, P. Geijo13, B. Roca14, T. Sánchez15, A. Terrón16, E. Deig17, E. Pedrol18, E. Ribera19, P. Viciana20, P. Domingo21, F. Lozano22, M.J. Galindo23, M. Garrido24, VACH Study Group


1Hospital de Sierrallana, Torrelavega, Spain, 2Hospital de Basurto, Bilbao, Spain, 3Hospital Infanta Elena, Huelva, Spain, 4Hospital de Albacete, Albacete, Spain, 5Hospital Infanta Cristina, Badajoz, Spain, 6Hospital de Cabueñes, Gijón, Spain, 7Hospital La Fe, Valencia, Spain, 8Hospital Clínico, Puerto Real, Spain, 9Hospital Arnau de Vilanova, Lleida, Spain, 10Hospital Joan XXIII, Tarragona, Spain, 11Hospital Carlos Haya, Malaga, Spain, 12Hospital Clínico de San Carlos, Madrid, Spain, 13Hospital Virgen de la Luz, Cuenca, Spain, 14Hospital General, Castellón, Spain, 15Hospital Virgen del Rosell, Cartagena, Spain, 16Hospital del SAS, Jerez de la Frontera, Spain, 17Hospital General, Granollers, Spain, 18Xarxa Sanitaria i Social Santa Tecla, Tarragona, Spain, 19Hospital Vall d´Hebrón, Barcelona, Spain, 20Hospital Virgen del Rocío, Sevilla, Spain, 21Hospital Santa Creu i Sant Pau, Barcelona, Spain, 22Hospital de Valme, Sevilla, Spain, 23Hospital Clínico, Valencia, Spain, 24VACH Study Group Data Management, Huelva, Spain

Background: Current assays for plasma HIV-RNA detect levels as low as 20 copies/ml. Most studies regarding prognosis of HIV infection and efficacy of antiretroviral therapy (ART) were performed using higher cut-off levels. We aimed at investigating the meaning of very low levels of viremia (VLoLV)(20-50 copies/mL), which is still uncertain.
Methods: The VACH Study Group is an open cohort of HIV-infected adults in Spain. We selected those patients who started ART after January 1997 and achieved effective viral suppression (2 consecutive viral loads (VL) below 50 cop/mL) followed by full suppression (at least 1 VL below 20 cop/mL). We performed survival analyses to study whether the occurrence of VLoLV as compared with maintaining full suppression below 20 would be associated with virological failure (VF) (2 consecutive VLs over 200 cop/mL, or 1 VL over 200 followed by change of ART regimen, administrative censoring or loss of follow-up), adjusted for nadir CD4 cell count, sex, age, ethnicity, transmission group, and time on effective suppression below 50.
Results: Out of 21480 patients who started ART after January 1997 (4851 women:23.6%), 13674 (63.7%) achieved effective suppression below 50, of whom 6834 (31.8%) further achieved full suppression below 20 (1601 women:23.4%). 1816 (26.6%) remained fully suppressed afterwards, while 5018 had one or more episodes of VL detection over 20 cop/mL (excluding VF). Loss of full suppression was associated with an increased risk of VF in the bivariate analysis (Hazard Ratio/HR: 15.80, 95% confidence interval/CI): 9.31-26.81), as were the nadir CD4 cell count, ethnicity, age and time on effective suppression below 50, but not sex or transmission group. 731 patients had VLoLV after full suppression below 20. VLoLV was not associated with VF as compared with persistent full suppression (HR: 0.82, 95% CI: 0.29-2.30), independently of the number of blips recorded (from 1 up to 18) and did not differ by sex.
Conclusions: : In HIV-infected adults on ART who achieve full suppression below 20 copies/mL, both VLoLV (between 20 and 50 copies/ml) and persistent full suppression are associated with lower risk of VF as compared with patients experiencing viremic blips over 50 copies/mL


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