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Determinants of virological failure after successful viral load suppression in first-line highly active antiretroviral therapy.
Antivir Ther. 2008; 13(7):927-36.AT

Abstract

BACKGROUND

We aimed to investigate the long-term virological outcomes of a cohort initially showing good responses to first-line highly active antiretroviral therapy (HAART) with no evidence ofvirological failure during the first year after achieving viral load (VL) undetectability (<50 copies/ml).

METHODS

Virological failure was defined as a confirmed VL >400 copies/ml or a single VL >400 copies/ml followed by a treatment change or end of follow-up. Risk factors for low-level VL rebound (50-400 copies/ml) in the first year after achieving undetectability and for virological failure during subsequent follow-up were investigated by logistic and Poisson regression.

RESULTS

In the first year after achieving VL undetectability, 354/1386 (25.5%) patients experienced low-level VL rebound, the remaining patients maintained consistent undetectability. Low-level rebound occurred less commonly with non-nucleoside reverse transcriptase inhibitor (NNRTI)-based HAART than with other regimens (P = 0.01). Over median 2.2 (range 0.0-7.4) years of subsequent follow-up, 86 (6.2%) patients experienced virological failure, corresponding to 2.30 failures per 100 person-years (95% confidence interval [CI] 1.82-2.79). Independent predictors of virological failure included low-level rebound during the first year after achieving undetectability relative to consistent undetectability (rate ratio [RR] 2.18, 95%0 CI 1.15-4.10), female gender (RR 1.79, 95% CI 1.12-2.85) and receiving a ritonavir-boosted protease inhibitor (Pl/r) relative to NNRTI-based HAART (RR 1.88, 95% CI 1.02-3.46).

CONCLUSIONS

Patients on first-line HAART who maintain consistent VL undetectability for 1 year have a low risk of subsequent virological failure. A subset might benefit from targeted interventions, including women and patients on Pl/r-based HAART.

Authors+Show Affiliations

Royal Free and University College Medical School, London, UK. a.geretti@medsch.ucl.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19043927

Citation

Geretti, Anna M., et al. "Determinants of Virological Failure After Successful Viral Load Suppression in First-line Highly Active Antiretroviral Therapy." Antiviral Therapy, vol. 13, no. 7, 2008, pp. 927-36.
Geretti AM, Smith C, Haberl A, et al. Determinants of virological failure after successful viral load suppression in first-line highly active antiretroviral therapy. Antivir Ther. 2008;13(7):927-36.
Geretti, A. M., Smith, C., Haberl, A., Garcia-Diaz, A., Nebbia, G., Johnson, M., Phillips, A., & Staszewski, S. (2008). Determinants of virological failure after successful viral load suppression in first-line highly active antiretroviral therapy. Antiviral Therapy, 13(7), 927-36.
Geretti AM, et al. Determinants of Virological Failure After Successful Viral Load Suppression in First-line Highly Active Antiretroviral Therapy. Antivir Ther. 2008;13(7):927-36. PubMed PMID: 19043927.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Determinants of virological failure after successful viral load suppression in first-line highly active antiretroviral therapy. AU - Geretti,Anna M, AU - Smith,Colette, AU - Haberl,Annette, AU - Garcia-Diaz,Ana, AU - Nebbia,Gaia, AU - Johnson,Margaret, AU - Phillips,Andrew, AU - Staszewski,Schlomo, PY - 2008/12/3/pubmed PY - 2009/1/6/medline PY - 2008/12/3/entrez SP - 927 EP - 36 JF - Antiviral therapy JO - Antivir Ther VL - 13 IS - 7 N2 - BACKGROUND: We aimed to investigate the long-term virological outcomes of a cohort initially showing good responses to first-line highly active antiretroviral therapy (HAART) with no evidence ofvirological failure during the first year after achieving viral load (VL) undetectability (<50 copies/ml). METHODS: Virological failure was defined as a confirmed VL >400 copies/ml or a single VL >400 copies/ml followed by a treatment change or end of follow-up. Risk factors for low-level VL rebound (50-400 copies/ml) in the first year after achieving undetectability and for virological failure during subsequent follow-up were investigated by logistic and Poisson regression. RESULTS: In the first year after achieving VL undetectability, 354/1386 (25.5%) patients experienced low-level VL rebound, the remaining patients maintained consistent undetectability. Low-level rebound occurred less commonly with non-nucleoside reverse transcriptase inhibitor (NNRTI)-based HAART than with other regimens (P = 0.01). Over median 2.2 (range 0.0-7.4) years of subsequent follow-up, 86 (6.2%) patients experienced virological failure, corresponding to 2.30 failures per 100 person-years (95% confidence interval [CI] 1.82-2.79). Independent predictors of virological failure included low-level rebound during the first year after achieving undetectability relative to consistent undetectability (rate ratio [RR] 2.18, 95%0 CI 1.15-4.10), female gender (RR 1.79, 95% CI 1.12-2.85) and receiving a ritonavir-boosted protease inhibitor (Pl/r) relative to NNRTI-based HAART (RR 1.88, 95% CI 1.02-3.46). CONCLUSIONS: Patients on first-line HAART who maintain consistent VL undetectability for 1 year have a low risk of subsequent virological failure. A subset might benefit from targeted interventions, including women and patients on Pl/r-based HAART. SN - 1359-6535 UR - https://www.unboundmedicine.com/medline/citation/19043927/Determinants_of_virological_failure_after_successful_viral_load_suppression_in_first_line_highly_active_antiretroviral_therapy_ L2 - http://hivinsite.ucsf.edu/InSite?page=kb-03-03-05 DB - PRIME DP - Unbound Medicine ER -