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Factors associated with 10 years of continuous viral load suppression on HAART.
BMC Infect Dis. 2016 07 22; 16:351.BI

Abstract

BACKGROUND

The principal goal of HAART is sustained viral load (VL) suppression resulting in immune reconstitution and improved HIV outcomes. We studied the factors associated with 10 years of continuous VL suppression on HAART in the US Military HIV Natural History Study.

METHODS

Participants with continuous VL suppression (CS, n = 149) were compared to those who did not have continuous viral load suppression (NCS, n = 127) for ≥10 years on HAART. Factors associated with >10 years of VL suppression were evaluated by multivariate logistic regression. Additionally, association between CS and CD4 reconstitution was analyzed with a mixed effects model.

RESULTS

Compared to NCS participants, a lower proportion of CS participants started HAART in the early HAART era (66 vs 90 %, for years 1996-1999; p < 0.001) and had less antiretroviral use prior to HAART (37 vs 83 %; p < 0.001). At initial HAART, the median CD4 cell count was higher and VL was lower for CS compared to NCS participants (375 cells/uL [256, 499] vs 261 cells/uL [146, 400]; p < 0.001 and 4.4 log10 copies/mL [3.5, 4.9] vs 4.5 log10 copies/mL [3.8, 5.0]; p = 0.048, respectively). New AIDS events were lower during HAART (5 vs 13 %; p = 0.032) and post-HAART CD4 trajectories were greater for the CS compared to NCS group. Factors negatively associated with ≥10 years of VL suppression included log10 VL at first HAART (OR 0.61, 95 % CI 0.4, 0.92; p = 0.020) and antiretroviral use prior to HAART (OR 0.16, 95 % CI 0.06, 0.38; p < .001).

CONCLUSIONS

Sustained VL suppression is a key to long-term health in HIV-infected patients, as demonstrated by the lower proportion of AIDS events observed 10 years after HAART initiation. The current use of more potent and well-tolerated regimens may mitigate the negative factors of pre-HAART VL and prior ARV use encountered by treatment initiated in the early HAART era.

Authors+Show Affiliations

Internal Medicine Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, 78234, TX, USA.Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, 20814, MD, USA. Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive #100, Bethesda, 20817, MD, USA.Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, 20814, MD, USA. Infectious Disease Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, 78234, TX, USA. Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive #100, Bethesda, 20817, MD, USA.Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, 20814, MD, USA. Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive #100, Bethesda, 20817, MD, USA.Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, 20814, MD, USA. Naval Medical Center, 620 John Paul Jones Circle, Portsmouth, 23708, VA, USA. Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive #100, Bethesda, 20817, MD, USA.Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, 20814, MD, USA. Infectious Disease Service, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, 20889, MD, USA. Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive #100, Bethesda, 20817, MD, USA.Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, 20814, MD, USA. Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive #100, Bethesda, 20817, MD, USA.Internal Medicine Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, 78234, TX, USA. Jason.f.okulicz.mil@mail.mil. Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, 20814, MD, USA. Jason.f.okulicz.mil@mail.mil. Infectious Disease Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, 78234, TX, USA. Jason.f.okulicz.mil@mail.mil.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27449671

Citation

Bello, Kathryn J., et al. "Factors Associated With 10 Years of Continuous Viral Load Suppression On HAART." BMC Infectious Diseases, vol. 16, 2016, p. 351.
Bello KJ, Mesner O, O'Bryan TA, et al. Factors associated with 10 years of continuous viral load suppression on HAART. BMC Infect Dis. 2016;16:351.
Bello, K. J., Mesner, O., O'Bryan, T. A., Won, S. H., Lalani, T., Ganesan, A., Agan, B. K., & Okulicz, J. F. (2016). Factors associated with 10 years of continuous viral load suppression on HAART. BMC Infectious Diseases, 16, 351. https://doi.org/10.1186/s12879-016-1677-x
Bello KJ, et al. Factors Associated With 10 Years of Continuous Viral Load Suppression On HAART. BMC Infect Dis. 2016 07 22;16:351. PubMed PMID: 27449671.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factors associated with 10 years of continuous viral load suppression on HAART. AU - Bello,Kathryn J, AU - Mesner,Octavio, AU - O'Bryan,Thomas A, AU - Won,Seung Hyun, AU - Lalani,Tahaniyat, AU - Ganesan,Anuradha, AU - Agan,Brian K, AU - Okulicz,Jason F, Y1 - 2016/07/22/ PY - 2015/10/21/received PY - 2016/06/09/accepted PY - 2016/7/25/entrez PY - 2016/7/28/pubmed PY - 2017/7/1/medline KW - AIDS KW - CD4 cell count KW - HAART KW - HIV KW - Suppression KW - Viral load SP - 351 EP - 351 JF - BMC infectious diseases JO - BMC Infect Dis VL - 16 N2 - BACKGROUND: The principal goal of HAART is sustained viral load (VL) suppression resulting in immune reconstitution and improved HIV outcomes. We studied the factors associated with 10 years of continuous VL suppression on HAART in the US Military HIV Natural History Study. METHODS: Participants with continuous VL suppression (CS, n = 149) were compared to those who did not have continuous viral load suppression (NCS, n = 127) for ≥10 years on HAART. Factors associated with >10 years of VL suppression were evaluated by multivariate logistic regression. Additionally, association between CS and CD4 reconstitution was analyzed with a mixed effects model. RESULTS: Compared to NCS participants, a lower proportion of CS participants started HAART in the early HAART era (66 vs 90 %, for years 1996-1999; p < 0.001) and had less antiretroviral use prior to HAART (37 vs 83 %; p < 0.001). At initial HAART, the median CD4 cell count was higher and VL was lower for CS compared to NCS participants (375 cells/uL [256, 499] vs 261 cells/uL [146, 400]; p < 0.001 and 4.4 log10 copies/mL [3.5, 4.9] vs 4.5 log10 copies/mL [3.8, 5.0]; p = 0.048, respectively). New AIDS events were lower during HAART (5 vs 13 %; p = 0.032) and post-HAART CD4 trajectories were greater for the CS compared to NCS group. Factors negatively associated with ≥10 years of VL suppression included log10 VL at first HAART (OR 0.61, 95 % CI 0.4, 0.92; p = 0.020) and antiretroviral use prior to HAART (OR 0.16, 95 % CI 0.06, 0.38; p < .001). CONCLUSIONS: Sustained VL suppression is a key to long-term health in HIV-infected patients, as demonstrated by the lower proportion of AIDS events observed 10 years after HAART initiation. The current use of more potent and well-tolerated regimens may mitigate the negative factors of pre-HAART VL and prior ARV use encountered by treatment initiated in the early HAART era. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/27449671/Factors_associated_with_10_years_of_continuous_viral_load_suppression_on_HAART_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-016-1677-x DB - PRIME DP - Unbound Medicine ER -