Impact of pre-therapy viral load on virological response to modern first-line HAART
| Autor: | Guido Palamara, Alessandra Latini, Evangelo Boumis, Carlo Federico Perno, Chiara Tommasi, Federica Forbici, Claudia Alteri, Francesca Ceccherini-Silberstein, Rita Bellagamba, Caterina Gori, Maria Mercedes Santoro, Andrea Antinori, Pasquale Narciso, Daniele Armenia, Raffaella Libertone, Carmela Pinnetti, Vanni Borghi, Mario Santoro, Emanuele Nicastri, Cristina Mussini, Lavinia Fabeni, Adriana Ammassari, Valerio Tozzi, Andrea Calcagno, Valentina Svicher, Massimo Andreoni, Giovanni Di Perri, Philippe Flandre, A. R. Buonomini |
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| Jazyk: | angličtina |
| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Genotype First line Treatment outcome MEDLINE HIV Infections Treatment failure Virological response 03 medical and health sciences 0302 clinical medicine Recurrence Risk Factors Antiretroviral Therapy Highly Active Internal medicine medicine Humans Pharmacology (medical) Treatment Failure Viremia 030212 general & internal medicine Pharmacology 0303 health sciences 030306 microbiology business.industry Pre-Therapy virus diseases Middle Aged Viral Load Settore MED/07 - Microbiologia e Microbiologia Clinica Antiretroviral therapy CD4 Lymphocyte Count 3. Good health Treatment Outcome Infectious Diseases Immunology HIV-1 Female business Viral load |
| Zdroj: | Antiviral Therapy; Vol 18 |
| ISSN: | 1359-6535 |
| DOI: | 10.3851/IMP2531 |
| Popis: | Background We tested whether pre-HAART viraemia affects the achievement and maintenance of virological success in HIV-1-infected patients starting modern first-line therapies. Methods A total of 1,430 patients starting their first HAART (genotype-tailored) in 2008 (median; IQR: 2006–2009) were grouped according to levels of pre-HAART viraemia (≤30,000, 30,001–100,000, 100,001–300,000, 300,001–500,000 and >500,000 copies/ml). The impact of pre-therapy viraemia on the time to virological success (viraemia ≤50 copies/ml) and on the time to virological rebound (first of two consecutive viraemia values >50 copies/ml after virological success) were evaluated by Kaplan–Meier curves and Cox regression analyses. Results Median pre-HAART viraemia was 5.1 log10 copies/ml (IQR 4.5–5.5), and 53% of patients had viraemia >100,000 copies/ml. By week 48, the prevalence of patients reaching virological success was >90% in all pre-HAART viraemia ranges, with the only exception of range >500,000 copies/ml (virological success =83%; P500,000 copies/ml showed the lowest hazard of virological undetectability after adjusting for age, gender, pre-HAART CD4+ T-cell count, transmitted drug resistance, calendar year and third drug administered (adjusted hazard ratio [95% CI]: 0.27 [0.21, 0.35]; P500,000 copies/ml was also associated with higher probability of virological rebound compared with patients belonging to lower viraemia strata at weeks 4, 12 and 24 ( P=0.050). Conclusions At the time of modern HAART, and even though an average >90% of virological success, high pre-HAART viraemia remains an independent factor associated with delayed and decreased virological success. Patients starting HAART with >500,000 copies/ml represent a significant population that may deserve special attention. |
| Databáze: | OpenAIRE |
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