학술논문
Predictors of low‐level HIV viraemia and virological failure in the era of integrase inhibitors: A Spanish nationwide cohort.
Document Type
Article
Author
Álvarez, Hortensia; Rava, Marta; Martínez, Cristina; Portilla, Joaquín; Peraire, Joaquim; Rivero, Antonio; Cervero, Miguel; Mariño, Ana; Poveda, Eva; Llibre, Josep M.; Moreno, Santiago; Dalmau, David; Navarro, Maria Luisa; González, María Isabel; García, Federico; Iribarren, José Antonio; Gutiérrez, Félix; Rubio, Rafael; Vidal, Francesc; Berenguer, Juan
Source
Subject
*HIV infections
*ANTI-HIV agents
*HIV-positive persons
*HIV integrase inhibitors
*CONFIDENCE intervals
*VIRAL load
*MULTIVARIATE analysis
*REVERSE transcriptase inhibitors
*RNA
*RISK assessment
*TREATMENT failure
*VIREMIA
*DESCRIPTIVE statistics
*CD4 lymphocyte count
*NON-nucleoside reverse transcriptase inhibitors
*ODDS ratio
*LOGISTIC regression analysis
*LONGITUDINAL method
*NUCLEOSIDE reverse transcriptase inhibitors
*HIV
*DISEASE risk factors
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Language
ISSN
1464-2662
Abstract
Objectives: To pinpoint factors associated with low‐level viraemia (LLV) and virological failure (VF) in people living with HIV in the era of high‐efficacy antiretroviral treatment (ART) and widespread use of integrase strand transfer inhibitor (INSTIs)‐based ART. Methods: We included adults aged > 18 years starting their first ART between 2015 and 2018 in the Spanish HIV/AIDS Research Network National Cohort (CoRIS). Low‐level viraemia was defined as plasma viral load (pVL) of 50–199 copies/mL at weeks 48 and 72 and VF was defined as pVL ≥ 50 copies/mL at week 48 and pVL ≥ 200 copies/mL at week 72. Multivariable logistic regression models assessed the impact on LLV and VF of baseline CD4 T‐cell count, CD4/CD8 T‐cell ratio and pVL, initial ART classes, age at ART initiation, time between HIV diagnosis and ART initiation, gender and transmission route. Results: Out of 4186 participants, 3120 (76.0%) started INSTIs, 455 (11.1%) started boosted protease inhibitors (bPIs) and 443 (10.8%) started nonnucleoside reverse transcriptase inhibitors (NNRTIs), either of them with two nucleos(t)ide reverse transcriptase inhibitors (NRTIs). Low‐level viraemia was met in 2.5% of participants and VF in 4.3%. There were no significant differences throughout the years for both virological outcomes. Baseline HIV‐1 RNA > 5 log10 copies/mL was the only consistent predictor of higher risk of LLV [adjusted odds ratio (aOR) = 9.8, 95% confidence interval (CI): 2.0–48.3] and VF (aOR = 5.4, 95% CI: 1.9–15.1), even in participants treated with INSTIs. Conclusions: The rates of LLV and VF were low but remained steady throughout the years. Baseline HIV‐1 RNA > 5 log10 copies/mL showed a persistent association with LLV and VF even in participants receiving INSTIs. [ABSTRACT FROM AUTHOR]