How relevant is the HIV low level viremia and how is its management changing in the era of modern ART? A large cohort analysis.
Adult
Anti-HIV Agents
/ therapeutic use
Antiretroviral Therapy, Highly Active
Disease Management
Female
Genotype
HIV Infections
/ blood
HIV-1
/ genetics
Humans
Incidence
Italy
Male
Middle Aged
Mutation
RNA, Viral
/ blood
Retrospective Studies
Treatment Failure
Viral Load
/ drug effects
Viremia
/ drug therapy
Drug resistance mutations
GRT
HIV reservoir
Low level viremia
Residual viremia
Virological failure
Journal
Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology
ISSN: 1873-5967
Titre abrégé: J Clin Virol
Pays: Netherlands
ID NLM: 9815671
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
received:
26
08
2019
revised:
03
12
2019
accepted:
21
12
2019
pubmed:
14
1
2020
medline:
15
5
2021
entrez:
14
1
2020
Statut:
ppublish
Résumé
It is still unclear what might be the best management of people living with HIV (PLWHIV) with low level viremia (LLV) despite being on antiretroviral treatment (ART). Aim of our study is to describe the clinical management of PLWHIV with LLV followed in a large cohort. Retrospective cohort study. We included 1607 adult patients over a three-year period (2015-2017). Follow up continued until June, 30th 2019 or last available visit. We observed a low incidence of LLV (0.9 % in 2015, 0.7 % in 2016 and 0.4 % in 2017), with a total of 21 patients with persistent LLV (pLLV), i.e. two consecutive HIV-RNA determinations of 50-500 copies/ml after at least 4 months of viral suppression. Among them, 12 had low compliance to treatment. Genotype resistance test (GRT) was performed in 14 patients and demonstrated at least one resistance mutation in 85.7 %. We described three categories of patients with pLLV: i) those whose ART regimen was not adequate based on GRT; ii) those with presumed suboptimal drug exposure, consequence of low adherence and/or drug-drug interactions and iii) those in which pLLV remained unexplained. For the first two categories, optimization or intensification of ART regimen led to viral suppression in >80 % of patients. We observed only 2 (9.5 %) virological failures and 1 (4.8 %) persistence of LLV in patients who did not switch ART. In our cohort, the rate of LLV showed a decline in most recent years. Adherence and previous GRT should be carefully considered with the aim of further reducing the phenomenon.
Sections du résumé
BACKGROUND
It is still unclear what might be the best management of people living with HIV (PLWHIV) with low level viremia (LLV) despite being on antiretroviral treatment (ART).
OBJECTIVES
Aim of our study is to describe the clinical management of PLWHIV with LLV followed in a large cohort.
STUDY DESIGN
Retrospective cohort study.
RESULTS
We included 1607 adult patients over a three-year period (2015-2017). Follow up continued until June, 30th 2019 or last available visit. We observed a low incidence of LLV (0.9 % in 2015, 0.7 % in 2016 and 0.4 % in 2017), with a total of 21 patients with persistent LLV (pLLV), i.e. two consecutive HIV-RNA determinations of 50-500 copies/ml after at least 4 months of viral suppression. Among them, 12 had low compliance to treatment. Genotype resistance test (GRT) was performed in 14 patients and demonstrated at least one resistance mutation in 85.7 %. We described three categories of patients with pLLV: i) those whose ART regimen was not adequate based on GRT; ii) those with presumed suboptimal drug exposure, consequence of low adherence and/or drug-drug interactions and iii) those in which pLLV remained unexplained. For the first two categories, optimization or intensification of ART regimen led to viral suppression in >80 % of patients. We observed only 2 (9.5 %) virological failures and 1 (4.8 %) persistence of LLV in patients who did not switch ART.
CONCLUSIONS
In our cohort, the rate of LLV showed a decline in most recent years. Adherence and previous GRT should be carefully considered with the aim of further reducing the phenomenon.
Identifiants
pubmed: 31927152
pii: S1386-6532(19)30285-9
doi: 10.1016/j.jcv.2019.104255
pii:
doi:
Substances chimiques
Anti-HIV Agents
0
RNA, Viral
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
104255Informations de copyright
Copyright © 2019 Elsevier B.V. All rights reserved.