Virological blips and predictors of post treatment viral control after stopping ART started in primary HIV infection
<p>Background: Few individuals commencing antiretroviral therapy (ART) in primary HIV infection (PHI) maintain undetectable viremia after treatment cessation. Associated factors remain unclear given the importance of the phenomenon to cure research.</p><p> Methods: Using CASCADE da...
| Main Authors: | , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Lippincott, Williams & Wilkins
2017
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| _version_ | 1797051707292647424 |
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| author | Fidler, S Olson, A Bucher, H Fox, J Thornhill, J Morrison, C Muga, R Phillips, A Frater, J Porter, K |
| author_facet | Fidler, S Olson, A Bucher, H Fox, J Thornhill, J Morrison, C Muga, R Phillips, A Frater, J Porter, K |
| author_sort | Fidler, S |
| collection | OXFORD |
| description | <p>Background: Few individuals commencing antiretroviral therapy (ART) in primary HIV infection (PHI) maintain undetectable viremia after treatment cessation. Associated factors remain unclear given the importance of the phenomenon to cure research.</p><p> Methods: Using CASCADE data of seroconverters starting ART in PHI (≤6 months from seroconversion), we estimated proportions experiencing viral blips (>400 copies followed by <400 copies HIVRNA/ mL without alteration of regimen) while on ART. We used Cox models to examine the association between time from ART stop to loss of control (2 consecutive measurements >1000 copies per milliliter) and magnitude and frequency of blips while on ART, time from seroconversion to ART, time on ART, adjusting for mean number of HIV-RNA measurements/year while on ART, and other confounders.</p><p> Results: Seven hundred seventy-eight seroconverters started ART in PHI with ≥3 HIV-RNA measurements. Median interquartile range (IQR) ART duration was 16.2 (8.0-35.9) months, within which we observed 13% with ≥1 blip. Of 228 who stopped ART, 119 rebounded; time to loss of control was associated with longer interval between seroconversion and ART initiation [hazard ratio (HR) = 1.16 per month; 1.04, 1.28], and blips while on ART (HR = 1.71 per blip; 95% confidence interval = 0.94 to 3.10). Longer time on ART (HR = 0.84 per additional month; 0.76, 0.92) was associated with lower risk of losing control. Of 228 stopping ART, 22 (10%) maintained post treatment control (PTC), ie, HIV-RNA <50 copies per milliliter ≥24 months after ART cessation. </p><p>Conclusion: HIV viral blips on therapy are associated with subsequent viral rebound on stopping ART among individuals treated in PHI. Longer duration on ART is associated with a greater chance of PTC.</p> |
| first_indexed | 2024-03-06T18:23:17Z |
| format | Journal article |
| id | oxford-uuid:070b7ba9-9927-45b1-9204-d121ac7731df |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T18:23:17Z |
| publishDate | 2017 |
| publisher | Lippincott, Williams & Wilkins |
| record_format | dspace |
| spelling | oxford-uuid:070b7ba9-9927-45b1-9204-d121ac7731df2022-03-26T09:05:39ZVirological blips and predictors of post treatment viral control after stopping ART started in primary HIV infectionJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:070b7ba9-9927-45b1-9204-d121ac7731dfEnglishSymplectic Elements at OxfordLippincott, Williams & Wilkins2017Fidler, SOlson, ABucher, HFox, JThornhill, JMorrison, CMuga, RPhillips, AFrater, JPorter, K<p>Background: Few individuals commencing antiretroviral therapy (ART) in primary HIV infection (PHI) maintain undetectable viremia after treatment cessation. Associated factors remain unclear given the importance of the phenomenon to cure research.</p><p> Methods: Using CASCADE data of seroconverters starting ART in PHI (≤6 months from seroconversion), we estimated proportions experiencing viral blips (>400 copies followed by <400 copies HIVRNA/ mL without alteration of regimen) while on ART. We used Cox models to examine the association between time from ART stop to loss of control (2 consecutive measurements >1000 copies per milliliter) and magnitude and frequency of blips while on ART, time from seroconversion to ART, time on ART, adjusting for mean number of HIV-RNA measurements/year while on ART, and other confounders.</p><p> Results: Seven hundred seventy-eight seroconverters started ART in PHI with ≥3 HIV-RNA measurements. Median interquartile range (IQR) ART duration was 16.2 (8.0-35.9) months, within which we observed 13% with ≥1 blip. Of 228 who stopped ART, 119 rebounded; time to loss of control was associated with longer interval between seroconversion and ART initiation [hazard ratio (HR) = 1.16 per month; 1.04, 1.28], and blips while on ART (HR = 1.71 per blip; 95% confidence interval = 0.94 to 3.10). Longer time on ART (HR = 0.84 per additional month; 0.76, 0.92) was associated with lower risk of losing control. Of 228 stopping ART, 22 (10%) maintained post treatment control (PTC), ie, HIV-RNA <50 copies per milliliter ≥24 months after ART cessation. </p><p>Conclusion: HIV viral blips on therapy are associated with subsequent viral rebound on stopping ART among individuals treated in PHI. Longer duration on ART is associated with a greater chance of PTC.</p> |
| spellingShingle | Fidler, S Olson, A Bucher, H Fox, J Thornhill, J Morrison, C Muga, R Phillips, A Frater, J Porter, K Virological blips and predictors of post treatment viral control after stopping ART started in primary HIV infection |
| title | Virological blips and predictors of post treatment viral control after stopping ART started in primary HIV infection |
| title_full | Virological blips and predictors of post treatment viral control after stopping ART started in primary HIV infection |
| title_fullStr | Virological blips and predictors of post treatment viral control after stopping ART started in primary HIV infection |
| title_full_unstemmed | Virological blips and predictors of post treatment viral control after stopping ART started in primary HIV infection |
| title_short | Virological blips and predictors of post treatment viral control after stopping ART started in primary HIV infection |
| title_sort | virological blips and predictors of post treatment viral control after stopping art started in primary hiv infection |
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