Predictors of residual viraemia in patients on long-term suppressive antiretroviral therapy.

TitlePredictors of residual viraemia in patients on long-term suppressive antiretroviral therapy.
Publication TypeJournal Article
Year of Publication2013
AuthorsZheng L, Bosch RJ, Chan ES, Read S, Kearney M, Margolis DM, Mellors JW, Eron JJ, Gandhi RT
Corporate AuthorsDS Clinical Trials Group(ACTG) A5244 Team
JournalAntivir Ther
Volume18
Issue1
Pagination39-43
Date Published2013
ISSN2040-2058
KeywordsAdult, Age Factors, Aged, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Drug Administration Schedule, Female, HIV Infections, HIV-1, Humans, Male, Middle Aged, Polymerase Chain Reaction, Predictive Value of Tests, RNA, Viral, Viral Load, Viremia
Abstract

BACKGROUND: HIV-1-infected individuals with plasma RNA<50 copies/ml on antiretroviral therapy (ART) may have residual, low-level viraemia detectable by PCR assays that are able to detect a single copy of viral RNA (single-copy assay [SCA]). The clinical predictors of residual viraemia in patients on long-term suppressive ART are not yet fully understood.

METHODS: We evaluated factors associated with residual viraemia in patients on suppressive ART who underwent screening for a raltegravir intensification trial (ACTG A5244). The screened population was HIV-1-infected adults receiving ART for ≥ 12 months with pre-ART HIV-1 RNA>100,000 copies/ml and on-therapy RNA levels below detection limits of commercial assays for ≥ 6 months.

RESULTS: Of 103 patients eligible for analysis, the median age was 46 years and the median duration of viral suppression was 4.8 years. 62% had detectable viraemia (>0.2 copies/ml) by SCA (median 0.2 copies/ml, IQR <0.2-1.8). Younger patients had lower HIV-1 RNA levels than older individuals (r=0.27, P=0.005). Patients with virological suppression on ART for 2 years or less had higher residual viraemia than those with suppression for >2 years (median 2.3 versus 0.2 copies/ml; P=0.016).

CONCLUSIONS: Among HIV-1-infected patients with pre-ART HIV-1 RNA>100,000 copies/ml, residual viraemia was detectable in the majority (62%) despite many years of suppressive ART. Higher level viraemia was associated with older age and <2 years of virological suppression on ART. These findings should help in the selection of candidates for clinical trials of interventions designed to eliminate residual viraemia.

DOI10.3851/IMP2323
Alternate JournalAntivir. Ther. (Lond.)
PubMed ID22914318
PubMed Central IDPMC3578982
Grant List2P30 AI060354-06 / AI / NIAID NIH HHS / United States
AI 06834 / AI / NIAID NIH HHS / United States
P30 AI050410 / AI / NIAID NIH HHS / United States
P30 AI060354 / AI / NIAID NIH HHS / United States
R01 AI 694722 / AI / NIAID NIH HHS / United States
R01 AI066992 / AI / NIAID NIH HHS / United States
U01 AI068634 / AI / NIAID NIH HHS / United States
U01 AI068636 / AI / NIAID NIH HHS / United States
U01 AI069423 / AI / NIAID NIH HHS / United States
U01 AI069472 / AI / NIAID NIH HHS / United States
U01AI068636 / AI / NIAID NIH HHS / United States
UM1 AI069412 / AI / NIAID NIH HHS / United States