Outcomes following detection of low level plasma HIV RNA in HIV-infected patients previously virologically suppressed on antiretroviral therapy: a retrospective observational study
Annabelle M. Warren A , Allen C. Cheng A B , Kerrie Watson A , Sharon R. Lewin A C and Jennifer F. Hoy A D
+ Author Affiliations
- Author Affiliations
A Department of Infectious Diseases, The Alfred Hospital and Monash University, 55 Commercial Road, Melbourne, Vic. 3004, Australia.
B Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia.
C Peter Doherty Institute for Infection and Immunity, University of Melbourne, 782 Elizabeth Street, Melbourne, Vic. 3010, Australia.
D Corresponding author. Email: jennifer.hoy@monash.edu
Sexual Health 14(3) 238-243 https://doi.org/10.1071/SH16165
Submitted: 8 September 2016 Accepted: 23 January 2017 Published: 27 April 2017
Abstract
Background: Progressively sensitive assays for plasma HIV RNA have led to increased detection of plasma HIV RNA between 20 and 200 copies/ml, known as low level viremia (LLV) when recurrent or persistent, in HIV-infected patients on antiretroviral therapy (ART). The aim of this study was to determine outcomes following initial detection of LLV in an Australian cohort. Methods: A retrospective study using the HIV Service Database (Alfred Hospital) included all patients on ART who recorded plasma HIV RNA 20–200 copies/mL following prior virological suppression (viral load (VL) HIV RNA <20 copies/mL) over 2 years (2010 to 2012), with follow-up to June 2013. Factors associated with subsequent virological outcome were assessed via univariate and multivariate analysis. Results: Of 919 patients managed by The Alfred HIV service, 207 (22.5%) met inclusion criteria. Mean age was 48.8 years, 91.3% were male. During follow-up, 54% patients recorded no further HIV RNA 20–200 copies/mL (viral blip); 39% had recurrent or persistent VL 20–200 copies/mL (LLV); and 7% progressed to virological failure with VL >200 copies/mL. Factors associated with LLV included co-morbid type 2 diabetes, shorter prior virological suppression and lower nadir CD4 cell count. Clinician management of VL 20–200 copies/mL was generally conservative, with infrequent requests for genotypic analysis (3.3% cases) or change in ART (<1% cases). Conclusions: LLV following virological suppression is common, and occurred as an isolated viral blip in half the patients. Those patients with persistent or recurrent LLV had higher rates of type 2 diabetes, shorter prior virological suppression and lower nadir CD4 cell count.
Additional keywords: HIV/AIDS, low level viremia, surveillance.
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