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Plasma Human Immunodeficiency Virus 1 RNA and CD4+ T-Cell Counts Are Determinants of Virological Nonsuppression Outcomes With Initial Integrase Inhibitor-Based Regimens: A Prospective RESPOND Cohort Study.
Álvarez, Hortensia; Mocroft, Amanda; Ryom, Lene; Neesgaard, Bastian; Edwards, Simon; Svedhem, Veronica; Günthard, Huldrych F; Zangerle, Robert; Smith, Colette; Castagna, Antonella; d'Arminio Monforte, Antonella; Wit, Ferdinand; Stecher, Melanie; Lehman, Clara; Mussini, Cristina; Fontas, Eric; González, Eva; Wasmuth, Jan-Christian; Sönnerborg, Anders; De Wit, Stéphane; Chkhartishvili, Nikoloz; Stephan, Christoph; Petoumenos, Kathy; Jaschinski, Nadine; Vannappagari, Vani; Gallant, Joel; Young, Lital; Volny Anne, Alain; Greenberg, Lauren; Martín-Iguacel, Raquel; Poveda, Eva; Llibre, Josep M.
Afiliación
  • Álvarez H; Department of Internal Medicine, Infectious Diseases Unit, Complexo Hospitalario Universitario de Ferrol, Ferrol, SERGAS-A Coruña, Spain.
  • Mocroft A; Department of Biochemistry, Genetics and Immunology, Universidade de Vigo, Vigo, Spain.
  • Ryom L; CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
  • Neesgaard B; Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom.
  • Edwards S; CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
  • Svedhem V; Department of Infectious Diseases, Hvidovre University Hospital, Copenhagen, Denmark.
  • Günthard HF; CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
  • Zangerle R; Department of HIV, Mortimer Market Centre, London, United Kingdom.
  • Smith C; Department of Medicine, Medical Unit Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Huddinge, Sweden.
  • Castagna A; Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
  • d'Arminio Monforte A; Austrian HIV Cohort Study, Medizinische Universität Innsbruck, Innsbruck, Austria.
  • Wit F; The Royal Free HIV Cohort Study, Royal Free Hospital, University College London, London, United Kingdom.
  • Stecher M; San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy.
  • Lehman C; Italian Cohort Naive Antiretrovirals (ICONA), ASST Santi Paolo e Carlo, Milano, Italy.
  • Mussini C; AIDS Therapy Evaluation in the Netherlands (ATHENA) cohort, HIV Monitoring Foundation, Amsterdam, The Netherlands.
  • Fontas E; Division of Infectious Diseases, Department I of Internal Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany.
  • González E; Division of Infectious Diseases, Department I of Internal Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany.
  • Wasmuth JC; Modena HIV Cohort, Università degli Studi di Modena, Modena, Italy.
  • Sönnerborg A; Nice HIV Cohort, Université Côte d´Azur et Centre Hospitalier Universitaire, Nice, France.
  • De Wit S; PISCIS Cohort Study, Centre Estudis Epidemologics de ITS i VIH de Catalunya, Badalona, Spain.
  • Chkhartishvili N; Medical Department, University Hospital Bonn, Bonn, Germany.
  • Stephan C; Swedish InfCare HIV Cohort, Karolinska University Hospital, Stockholm, Sweden.
  • Petoumenos K; CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium.
  • Jaschinski N; Georgian National AIDS Health Information System, Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia.
  • Vannappagari V; Frankfurt HIV Cohort Study, University Hospital Frankfurt, Goethe-University, Infectious Diseases Unit, Frankfurt, Germany.
  • Gallant J; The Kirby Institute, University of New South Wales, Sydney, Australia.
  • Young L; CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
  • Volny Anne A; ViiV Healthcare, Research Triangle Park, North Carolina, USA.
  • Greenberg L; Gilead Sciences, Foster City, California, USA.
  • Martín-Iguacel R; Merck Sharp & Dohme, Luzern, Switzerland.
  • Poveda E; European AIDS Treatment Group, Brussels, Belgium.
  • Llibre JM; CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Clin Infect Dis ; 77(4): 593-605, 2023 08 22.
Article en En | MEDLINE | ID: mdl-37052343
BACKGROUND: There are conflicting data regarding baseline determinants of virological nonsuppression outcomes in persons with human immunodeficiency virus (HIV) starting antiretroviral treatment (ART). We evaluated the impact of different baseline variables in the RESPOND cohort. METHODS: We included treatment-naive participants aged ≥18 who initiated 3-drug ART, in 2014-2020. We assessed the odds of virological suppression (VS) at weeks 48 and 96 using logistic regression. Viral blips, low-level viremia (LLV), residual viremia (RV), and virological failure (VF) rates were assessed using Cox regression. RESULTS: Of 4310 eligible participants, 72% started integrase strand transfer inhibitor (INSTI)-based regimens. At 48 and 96 weeks, 91.0% and 93.3% achieved VS, respectively. At 48 weeks, Kaplan-Meier estimates of rates were 9.6% for viral blips, 2.1% for LLV, 22.2% for RV, and 2.1% for VF. Baseline HIV-1 RNA levels >100 000 copies/mL and CD4+ T-cell counts ≤200/µL were negatively associated with VS at weeks 48 (adjusted odds ratio, 0.51 [95% confidence interval, .39-.68] and .40 [.27-.58], respectively) and 96 and with significantly higher rates of blips, LLV, and RV. CD4+ T-cell counts ≤200/µL were associated with higher risk of VF (adjusted hazard ratio, 3.12 [95% confidence interval, 2.02-4.83]). Results were consistent in those starting INSTIs versus other regimens and those starting dolutegravir versus other INSTIs. CONCLUSIONS: Initial high HIV-1 RNA and low CD4+ T-cell counts are associated with lower rates of VS at 48 and 96 weeks and higher rates of viral blips, LLV, and RV. Low baseline CD4+ T-cell counts are associated with higher VF rates. These associations remain with INSTI-based and specifically with dolutegravir-based regimens. These findings suggest that the impact of these baseline determinants is independent of the ART regimen initiated.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: ARN Viral / Infecciones por VIH / VIH-1 / Inhibidores de Integrasa VIH Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Clin Infect Dis Asunto de la revista: DOENCAS TRANSMISSIVEIS Año: 2023 Tipo del documento: Article País de afiliación: España Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: ARN Viral / Infecciones por VIH / VIH-1 / Inhibidores de Integrasa VIH Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Clin Infect Dis Asunto de la revista: DOENCAS TRANSMISSIVEIS Año: 2023 Tipo del documento: Article País de afiliación: España Pais de publicación: Estados Unidos