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Factors associated with viral rebound among highly treatment-experienced HIV-positive patients who have achieved viral suppression

Smith, CJ; Phillips, AN; Dauer, B; Johnson, MA; Lampe, FC; Youle, MS; Tyrer, M; (2009) Factors associated with viral rebound among highly treatment-experienced HIV-positive patients who have achieved viral suppression. HIV MED , 10 (1) 19 - 27. 10.1111/j.1468-1293.2008.00650.x.

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Abstract

Objective More and more highly treatment-experienced patients are achieving viral suppression. However, the durability of suppression remains unclear.Methods Patients from Royal Free Hospital (London, UK) and JW Goethe University Hospital (Frankfurt, Germany) who had failed >= 1 antiretroviral (ARV) regimen in all three main drug classes and >= 3 previous ARV regimens and subsequently achieved viral load < 50 HIV-1 RNA copies/mL were included. They were followed until stopping pre-combination antiretroviral therapy, end of follow-up or viral rebound (two viral loads 4400 copies/mL).Results Two hundred and forty-seven patients contributed 723 person-years and 114 viral rebounds [rate = 15.8 per 100 person-years; 95% confidence interval (CI) 12.9-18.7]. More recent calendar years of viral suppression [relative risk (RR) = 0.90 per year later; 95% CI 0.81-1.00; P = 0.05] and greater number of ARVs in the regimen not previously failed (RR = 0.78 per 1 ARV more; 95% CI 0.65-0.95; P = 0.01) were associated with lower viral rebound rates. At 0-1, 1-2, 2-3 and 43 years after achieving suppression, the rebound rates were 30.9, 9.2, 4.3 and 3.5 per 100 person-years, respectively. Compared to 0-1 years, the adjusted RRs (95% CIs) after 1-2, 2-3 and 43 years were 0.33 (0.18-0.58), 0.21 (0.09-0.48) and 0.14 (0.06-0.33), respectively (P < 0.0001).Conclusions Although rebound rates are high, especially in the first year after viral suppression, this risk reduces substantially if highly treatment-experienced patients can maintain viral suppression.

Type: Article
Title: Factors associated with viral rebound among highly treatment-experienced HIV-positive patients who have achieved viral suppression
DOI: 10.1111/j.1468-1293.2008.00650.x
Keywords: antiretroviral therapy, three-class failure, viral rebound, ACTIVE ANTIRETROVIRAL THERAPY, PROTEASE INHIBITORS, RESISTANT HIV-1, TRIAL, LAMIVUDINE, EFAVIRENZ, INFECTION, EFFICACY, INDIVIDUALS, ENFUVIRTIDE
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health > Infection and Population Health
URI: http://discovery.ucl.ac.uk/id/eprint/138502
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