Universität zu Köln

Elvstam, Olof ORCID: 0000-0003-3799-9869, Malmborn, Kasper, Elen, Sixten ORCID: 0000-0002-6451-863X, Marrone, Gaetano, Garcia, Federico, Zazzi, Maurizio, Sonnerborg, Anders, Boehm, Michael, Seguin-Devaux, Carole ORCID: 0000-0003-0636-5222 and Bjorkman, Per (2023). Virologic Failure Following Low-level Viremia and Viral Blips During Antiretroviral Therapy: Results From a European Multicenter Cohort. Clin. Infect. Dis., 76 (1). S. 25 - 32. CARY: OXFORD UNIV PRESS INC. ISSN 1537-6591

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Abstract

Retrospective analysis of 22 523 people with HIV-1 receiving antiretroviral therapy indicates that both viral blips and low-level viremia of 51 to 199 copies/mL in repeated measurements are independent predictors of subsequent virologic failure. Background It is unclear whether low-level viremia (LLV), defined as repeatedly detectable viral load (VL) of <200 copies/mL, and/or transient viremic episodes (blips) during antiretroviral therapy (ART), predict future virologic failure. We investigated the association between LLV, blips, and virologic failure (VF) in a multicenter European cohort. Methods People with HIV-1 who started ART in 2005 or later were identified from the EuResist Integrated Database. We analyzed the incidence of VF (>= 200 copies/mL) depending on viremia exposure, starting 12 months after ART initiation (grouped as suppression [<= 50 copies/mL], blips [isolated VL of 51-999 copies/mL], and LLV [repeated VLs of 51-199 copies/mL]) using Cox proportional hazard models adjusted for age, sex, injecting drug use, pre-ART VL, CD4 count, HIV-1 subtype, type of ART, and treatment experience. We queried the database for drug-resistance mutations (DRM) related to episodes of LLV and VF and compared those with baseline resistance data. Results During 81 837 person-years of follow-up, we observed 1424 events of VF in 22 523 participants. Both blips (adjusted subhazard ratio [aHR], 1.7; 95% confidence interval [CI], 1.3-2.2) and LLV (aHR, 2.2; 95% CI, 1.6-3.0) were associated with VF, compared with virologic suppression. These associations remained statistically significant in subanalyses restricted to people with VL <200 copies/mL and those starting ART 2014 or later. Among people with LLV and genotype data available within 90 days following LLV, 49/140 (35%) had at least 1 DRM. Conclusions Both blips and LLV during ART are associated with increased risk of subsequent VF.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Elvstam, Olof UNSPECIFIED orcid.org/0000-0003-3799-9869 UNSPECIFIED Malmborn, Kasper UNSPECIFIED UNSPECIFIED UNSPECIFIED Elen, Sixten UNSPECIFIED orcid.org/0000-0002-6451-863X UNSPECIFIED Marrone, Gaetano UNSPECIFIED UNSPECIFIED UNSPECIFIED Garcia, Federico UNSPECIFIED UNSPECIFIED UNSPECIFIED Zazzi, Maurizio UNSPECIFIED UNSPECIFIED UNSPECIFIED Sonnerborg, Anders UNSPECIFIED UNSPECIFIED UNSPECIFIED Boehm, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Seguin-Devaux, Carole UNSPECIFIED orcid.org/0000-0003-0636-5222 UNSPECIFIED Bjorkman, Per UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-690200
DOI:	10.1093/cid/ciac762
Journal or Publication Title:	Clin. Infect. Dis.
Volume:	76
Number:	1
Page Range:	S. 25 - 32
Date:	2023
Publisher:	OXFORD UNIV PRESS INC
Place of Publication:	CARY
ISSN:	1537-6591
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language DRUG-RESISTANCE MUTATIONS; HIV-INFECTED INDIVIDUALS; HIV-1-INFECTED PATIENTS; PREVALENCE; RISK; OUTCOMES; EVENTS Multiple languages Immunology; Infectious Diseases; Microbiology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/69020