Impact of low-level viremia on clinical and virological outcomes in treated HIV-1-infected patients

Marie-Anne Vandenhende; Suzanne Ingle; Margaret May; Geneviève Chene; Robert Zangerle; Ard Van Sighem; M John Gill; Carolynne Schwarze-Zander; Beatriz Hernandez-Novoa; Niels Obel; Ole Kirk; Sophie Abgrall; Jodie Guest; Hasina Samji; Antonella D'Arminio Monforte; Josep M Llibre; Colette Smith; Matthias Cavassini; Greer A Burkholder; Bryan Shepherd; Heidi M Crane; Jonathan Sterne; Philippe Morlat; Antiretroviral Therapy Cohort Collaboration (ART-CC)

doi:10.1097/QAD.0000000000000544

Impact of low-level viremia on clinical and virological outcomes in treated HIV-1-infected patients

Marie-Anne Vandenhende, Suzanne Ingle, Margaret May, Geneviève Chene, Robert Zangerle, Ard Van Sighem, M John Gill, Carolynne Schwarze-Zander, Beatriz Hernandez-Novoa, Niels Obel, Ole Kirk, Sophie Abgrall, Jodie Guest, Hasina Samji, Antonella D'Arminio Monforte, Josep M Llibre, Colette Smith, Matthias Cavassini, Greer A Burkholder, Bryan ShepherdHeidi M Crane, Jonathan Sterne, Philippe Morlat, Antiretroviral Therapy Cohort Collaboration (ART-CC)

Department of Clinical Medicine

50 Citations (Scopus)

Abstract

BACKGROUND: The goal of antiretroviral therapy (ART) is to reduce HIV-related morbidity and mortality by suppressing HIV replication. The prognostic value of persistent low-level viremia (LLV), particularly for clinical outcomes, is unknown.

OBJECTIVE: Assess the association of different levels of LLV with virological failure, AIDS event, and death among HIV-infected patients receiving combination ART.

METHODS: We analyzed data from 18 cohorts in Europe and North America, contributing to the ART Cohort Collaboration. Eligible patients achieved viral load below 50 copies/ml within 3-9 months after ART initiation. LLV50-199 was defined as two consecutive viral loads between 50 and 199 copies/ml and LLV200-499 as two consecutive viral loads between 50 and 499 copies/ml, with at least one between 200 and 499 copies/ml. We used Cox models to estimate the association of LLV with virological failure (two consecutive viral loads at least 500 copies/ml or one viral load at least 500 copies/ml, followed by a modification of ART) and AIDS event/death.

RESULTS: Among 17 902 patients, 624 (3.5%) experienced LLV50-199 and 482 (2.7%) LLV200-499. Median follow-up was 2.3 and 3.1 years for virological and clinical outcomes, respectively. There were 1903 virological failure, 532 AIDS events and 480 deaths. LLV200-499 was strongly associated with virological failure [adjusted hazard ratio (aHR) 3.97, 95% confidence interval (CI) 3.05-5.17]. LLV50-199 was weakly associated with virological failure (aHR 1.38, 95% CI 0.96-2.00). LLV50-199 and LLV200-499 were not associated with AIDS event/death (aHR 1.13, 95% CI 0.81-1.68; and aHR 0.95, 95% CI 0.62-1.48, [corrected] respectively).

CONCLUSION: LLV200-499 was strongly associated with virological failure, but not with AIDS event/death. Our results support the US guidelines, which define virological failure as a confirmed viral load above 200 copies/ml.

Original language	English
Journal	AIDS (London, England)
Volume	29
Issue number	3
Pages (from-to)	373-83
Number of pages	11
ISSN	0269-9370
DOIs	https://doi.org/10.1097/QAD.0000000000000544
Publication status	Published - 28 Jan 2015

Keywords

Adult
Anti-Retroviral Agents
Antiretroviral Therapy, Highly Active
Europe
Female
HIV Infections
HIV-1
Humans
Male
Middle Aged
North America
Prognosis
Survival Analysis
Treatment Outcome
Viral Load
Viremia

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/QAD.0000000000000544

Cite this

Vandenhende, M.-A., Ingle, S., May, M., Chene, G., Zangerle, R., Van Sighem, A., Gill, M. J., Schwarze-Zander, C., Hernandez-Novoa, B., Obel, N., Kirk, O., Abgrall, S., Guest, J., Samji, H., D'Arminio Monforte, A., Llibre, J. M., Smith, C., Cavassini, M., Burkholder, G. A., ... Antiretroviral Therapy Cohort Collaboration (ART-CC) (2015). Impact of low-level viremia on clinical and virological outcomes in treated HIV-1-infected patients. AIDS (London, England), 29(3), 373-83. https://doi.org/10.1097/QAD.0000000000000544

Vandenhende, M-A, Ingle, S, May, M, Chene, G, Zangerle, R, Van Sighem, A, Gill, MJ, Schwarze-Zander, C, Hernandez-Novoa, B, Obel, N , Kirk, O, Abgrall, S, Guest, J, Samji, H, D'Arminio Monforte, A, Llibre, JM, Smith, C, Cavassini, M, Burkholder, GA, Shepherd, B, Crane, HM, Sterne, J, Morlat, P & Antiretroviral Therapy Cohort Collaboration (ART-CC) 2015, 'Impact of low-level viremia on clinical and virological outcomes in treated HIV-1-infected patients', AIDS (London, England), vol. 29, no. 3, pp. 373-83. https://doi.org/10.1097/QAD.0000000000000544

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title = "Impact of low-level viremia on clinical and virological outcomes in treated HIV-1-infected patients",

abstract = "BACKGROUND: The goal of antiretroviral therapy (ART) is to reduce HIV-related morbidity and mortality by suppressing HIV replication. The prognostic value of persistent low-level viremia (LLV), particularly for clinical outcomes, is unknown.OBJECTIVE: Assess the association of different levels of LLV with virological failure, AIDS event, and death among HIV-infected patients receiving combination ART.METHODS: We analyzed data from 18 cohorts in Europe and North America, contributing to the ART Cohort Collaboration. Eligible patients achieved viral load below 50 copies/ml within 3-9 months after ART initiation. LLV50-199 was defined as two consecutive viral loads between 50 and 199 copies/ml and LLV200-499 as two consecutive viral loads between 50 and 499 copies/ml, with at least one between 200 and 499 copies/ml. We used Cox models to estimate the association of LLV with virological failure (two consecutive viral loads at least 500 copies/ml or one viral load at least 500 copies/ml, followed by a modification of ART) and AIDS event/death.RESULTS: Among 17 902 patients, 624 (3.5%) experienced LLV50-199 and 482 (2.7%) LLV200-499. Median follow-up was 2.3 and 3.1 years for virological and clinical outcomes, respectively. There were 1903 virological failure, 532 AIDS events and 480 deaths. LLV200-499 was strongly associated with virological failure [adjusted hazard ratio (aHR) 3.97, 95% confidence interval (CI) 3.05-5.17]. LLV50-199 was weakly associated with virological failure (aHR 1.38, 95% CI 0.96-2.00). LLV50-199 and LLV200-499 were not associated with AIDS event/death (aHR 1.13, 95% CI 0.81-1.68; and aHR 0.95, 95% CI 0.62-1.48, [corrected] respectively).CONCLUSION: LLV200-499 was strongly associated with virological failure, but not with AIDS event/death. Our results support the US guidelines, which define virological failure as a confirmed viral load above 200 copies/ml.",

keywords = "Adult, Anti-Retroviral Agents, Antiretroviral Therapy, Highly Active, Europe, Female, HIV Infections, HIV-1, Humans, Male, Middle Aged, North America, Prognosis, Survival Analysis, Treatment Outcome, Viral Load, Viremia",

author = "Marie-Anne Vandenhende and Suzanne Ingle and Margaret May and Genevi{\`e}ve Chene and Robert Zangerle and {Van Sighem}, Ard and Gill, {M John} and Carolynne Schwarze-Zander and Beatriz Hernandez-Novoa and Niels Obel and Ole Kirk and Sophie Abgrall and Jodie Guest and Hasina Samji and {D'Arminio Monforte}, Antonella and Llibre, {Josep M} and Colette Smith and Matthias Cavassini and Burkholder, {Greer A} and Bryan Shepherd and Crane, {Heidi M} and Jonathan Sterne and Philippe Morlat and {Antiretroviral Therapy Cohort Collaboration (ART-CC)}",

year = "2015",

month = jan,

day = "28",

doi = "10.1097/QAD.0000000000000544",

language = "English",

volume = "29",

pages = "373--83",

journal = "AIDS (London, England)",

issn = "0269-9370",

publisher = "Lippincott Williams & Wilkins",

number = "3",

}

TY - JOUR

T1 - Impact of low-level viremia on clinical and virological outcomes in treated HIV-1-infected patients

AU - Vandenhende, Marie-Anne

AU - Ingle, Suzanne

AU - May, Margaret

AU - Chene, Geneviève

AU - Zangerle, Robert

AU - Van Sighem, Ard

AU - Gill, M John

AU - Schwarze-Zander, Carolynne

AU - Hernandez-Novoa, Beatriz

AU - Obel, Niels

AU - Kirk, Ole

AU - Abgrall, Sophie

AU - Guest, Jodie

AU - Samji, Hasina

AU - D'Arminio Monforte, Antonella

AU - Llibre, Josep M

AU - Smith, Colette

AU - Cavassini, Matthias

AU - Burkholder, Greer A

AU - Shepherd, Bryan

AU - Crane, Heidi M

AU - Sterne, Jonathan

AU - Morlat, Philippe

AU - Antiretroviral Therapy Cohort Collaboration (ART-CC)

PY - 2015/1/28

Y1 - 2015/1/28

N2 - BACKGROUND: The goal of antiretroviral therapy (ART) is to reduce HIV-related morbidity and mortality by suppressing HIV replication. The prognostic value of persistent low-level viremia (LLV), particularly for clinical outcomes, is unknown.OBJECTIVE: Assess the association of different levels of LLV with virological failure, AIDS event, and death among HIV-infected patients receiving combination ART.METHODS: We analyzed data from 18 cohorts in Europe and North America, contributing to the ART Cohort Collaboration. Eligible patients achieved viral load below 50 copies/ml within 3-9 months after ART initiation. LLV50-199 was defined as two consecutive viral loads between 50 and 199 copies/ml and LLV200-499 as two consecutive viral loads between 50 and 499 copies/ml, with at least one between 200 and 499 copies/ml. We used Cox models to estimate the association of LLV with virological failure (two consecutive viral loads at least 500 copies/ml or one viral load at least 500 copies/ml, followed by a modification of ART) and AIDS event/death.RESULTS: Among 17 902 patients, 624 (3.5%) experienced LLV50-199 and 482 (2.7%) LLV200-499. Median follow-up was 2.3 and 3.1 years for virological and clinical outcomes, respectively. There were 1903 virological failure, 532 AIDS events and 480 deaths. LLV200-499 was strongly associated with virological failure [adjusted hazard ratio (aHR) 3.97, 95% confidence interval (CI) 3.05-5.17]. LLV50-199 was weakly associated with virological failure (aHR 1.38, 95% CI 0.96-2.00). LLV50-199 and LLV200-499 were not associated with AIDS event/death (aHR 1.13, 95% CI 0.81-1.68; and aHR 0.95, 95% CI 0.62-1.48, [corrected] respectively).CONCLUSION: LLV200-499 was strongly associated with virological failure, but not with AIDS event/death. Our results support the US guidelines, which define virological failure as a confirmed viral load above 200 copies/ml.

AB - BACKGROUND: The goal of antiretroviral therapy (ART) is to reduce HIV-related morbidity and mortality by suppressing HIV replication. The prognostic value of persistent low-level viremia (LLV), particularly for clinical outcomes, is unknown.OBJECTIVE: Assess the association of different levels of LLV with virological failure, AIDS event, and death among HIV-infected patients receiving combination ART.METHODS: We analyzed data from 18 cohorts in Europe and North America, contributing to the ART Cohort Collaboration. Eligible patients achieved viral load below 50 copies/ml within 3-9 months after ART initiation. LLV50-199 was defined as two consecutive viral loads between 50 and 199 copies/ml and LLV200-499 as two consecutive viral loads between 50 and 499 copies/ml, with at least one between 200 and 499 copies/ml. We used Cox models to estimate the association of LLV with virological failure (two consecutive viral loads at least 500 copies/ml or one viral load at least 500 copies/ml, followed by a modification of ART) and AIDS event/death.RESULTS: Among 17 902 patients, 624 (3.5%) experienced LLV50-199 and 482 (2.7%) LLV200-499. Median follow-up was 2.3 and 3.1 years for virological and clinical outcomes, respectively. There were 1903 virological failure, 532 AIDS events and 480 deaths. LLV200-499 was strongly associated with virological failure [adjusted hazard ratio (aHR) 3.97, 95% confidence interval (CI) 3.05-5.17]. LLV50-199 was weakly associated with virological failure (aHR 1.38, 95% CI 0.96-2.00). LLV50-199 and LLV200-499 were not associated with AIDS event/death (aHR 1.13, 95% CI 0.81-1.68; and aHR 0.95, 95% CI 0.62-1.48, [corrected] respectively).CONCLUSION: LLV200-499 was strongly associated with virological failure, but not with AIDS event/death. Our results support the US guidelines, which define virological failure as a confirmed viral load above 200 copies/ml.

KW - Adult

KW - Anti-Retroviral Agents

KW - Antiretroviral Therapy, Highly Active

KW - Europe

KW - Female

KW - HIV Infections

KW - HIV-1

KW - Humans

KW - Male

KW - Middle Aged

KW - North America

KW - Prognosis

KW - Survival Analysis

KW - Treatment Outcome

KW - Viral Load

KW - Viremia

U2 - 10.1097/QAD.0000000000000544

DO - 10.1097/QAD.0000000000000544

M3 - Journal article

C2 - 25686685

SN - 0269-9370

VL - 29

SP - 373

EP - 383

JO - AIDS (London, England)

JF - AIDS (London, England)

IS - 3

ER -

Impact of low-level viremia on clinical and virological outcomes in treated HIV-1-infected patients

Abstract

Keywords

UN SDGs

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