Presentation Abstract

Session: 179-HIV-I Pathogenesis and Predictors of Antiretroviral Response in Treatment and Prevention
Tuesday, Sep 11, 2012, 11:15 AM - 1:15 PM
Presentation Title: H-1566 - Persistent Low-level Viraemia in HIV-1-infected Patients: Swiss HIV Cohort Study
Location: Halls A-C
Presentation Number: H-1566
Pres. Time: Tuesday, Sep 11, 2012, 11:30 AM - 1:30 PM
Category: H3
Keywords: HIV low-level viremia; HIV undetectability; salvage therapy
Author(s): N. Boillat Blanco, MD - Research Ass. 1, K. Darling, PhD - Registrar1, F. Schöni-Affolter, MD - Statistician 2, H. Günthard, MD - Professor 3, R. Fulchini, MD - Registrar 4, M. Rougemont, MD - Registrar 5, E. Bernasconi, MD - Professor 6, D. Vuichard, MD - Registrar 7, H. Furrer, MD - Professor 8, O. Clerc, MD - Registrar 1, M. Cavassini, MD - Registrar 1;
1Univ., Lausanne, Switzerland, 2SHCS Data Ctr., Lausanne, Switzerland, 3Univ., Zurich, Switzerland, 4Hosp., St. Gallen, Switzerland, 5Univ., Geneva, Switzerland, 6Hosp., Lugano, Switzerland, 7Univ., Basel, Switzerland, 8Univ., Bern, Switzerland.
Financial Disclosures:  N. Boillat Blanco,
MSD Role(s): Grant Investigator.
K. Darling, None..
F. Schöni-Affolter, None. 
H. Günthard,
GlaxoSmithKline Role(s): Consultant.
Abbott Role(s): Consultant.
Novartis Role(s): Consultant.
Boehringer Ingelheim Role(s): Consultant.
Roche Role(s): Consultant.
Tibotec Role(s): Consultant.
Bristol-Myers Squibb Role(s): Consultant.
R. Fulchini, None..
M. Rougemont, None. 
E. Bernasconi,
BMS Role(s): Consultant.
Gilead Role(s): Consultant, Grant Investigator.
ViiV Healthcare Role(s): Consultant.
Pfizer Role(s): Consultant.
MSD Role(s): Consultant, Grant Investigator.
Janssen Role(s): Consultant.
Abbott Role(s): Grant Investigator.
Roche Role(s): Grant Investigator.
D. Vuichard, None. 
H. Furrer,
Abbott Role(s): Grant Investigator, Scientific Advisor (Review Panel or Advisory Committee).
BMS Role(s): Grant Investigator, Scientific Advisor (Review Panel or Advisory Committee).
ViiV Healthcare Role(s): Grant Investigator, Scientific Advisor (Review Panel or Advisory Committee).
Roche Role(s): Grant Investigator, Scientific Advisor (Review Panel or Advisory Committee).
Gilead Role(s): Grant Investigator, Scientific Advisor (Review Panel or Advisory Committee).
MSD Role(s): Grant Investigator, Scientific Advisor (Review Panel or Advisory Committee).
Boehringer-Ingelheim Role(s): Grant Investigator, Scientific Advisor (Review Panel or Advisory Committee).
Tibotec-Janssen Role(s): Grant Investigator, Scientific Advisor (Review Panel or Advisory Committee).
O. Clerc, None..
M. Cavassini, None.
Abstract: Background: Low-level viraemia (LLV) may arise in patients with previously undetectable HIV viral loads (VL) on cART. It is important to know the implications of LLV and the benefit of cART-change. Methods: Case-control study. Patients enrolled from1 January 2000 to 31 December 2010, undetectable for ≥24 weeks on cART, presenting a persistent LLV (VL 21-400 copies/mL on ≥3 consecutive plasma samples with ≥8 weeks between first and last analyses) without cART-change were compared to controls with ≥3 consecutive VL values ≤20 copies/mL for ≥32 weeks without cART-change. Results: We studied 179 patients with LLV and 5389 controls. Compared to controls, patients with LLV had worse cART adherence (aOR[95%CI] 1.9[1-3.3]) and were less often on NNRTI cART (aOR 0.5[0.3-0.8]). More patients had LLV after 2008 (aOR 6.4[3.5-11.4)]). Most patients (n=102; 66%) still had LLV at 48 weeks while 19 (12%) presented virological failure (VF=VL>400copies/mL). Predictors of VF were diabetes (aOR 12.6[2-81]) and suboptimal adherence (aOR 5.3[1.5-18.9]). No patient with very LLV (VLLV=21-49 copies/mL; N=26) experienced VF. 48 weeks after last LLV, 51 (28%) patients changed cART; predictors were being on NRTI only regimens (aOR 9.6[1.6-6.7)]), nadir CD4 count ≤200 (aOR 5[1.4-18.3]) and LLV onset after 2008 (aOR 3.8[1.1-12.3]). Of 43 patients with cART-change, 63% had undetectable VLs by 24 weeks compared to 33% without change (P=0.001). VF occurred in 9% post-change and in 12% on unchanged cART (P=0.8). Conclusions: Progression to VF occurs in a minority of patients up to a year post-LLV and in no patient with VLLV. cART change is driven mainly by cART regimen at LLV onset and availability of new classes of ARV drug. Whilst the majority of changing patients achieved undetectable VLs, change did not affect the rate of VF.




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