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History of viral suppression on combination antiretroviral therapy as a predictor of virological failure after a treatment change*

Reekie, J; Mocroft, A; Ledergerber, B; Beniowski, M; Clotet, B; van Lunzen, J; Chiesi, A; ... EuroSIDA Study Grp, ; + view all (2010) History of viral suppression on combination antiretroviral therapy as a predictor of virological failure after a treatment change*. HIV MED , 11 (7) 469 - 478. 10.1111/j.1468-1293.2009.00816.x.

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Abstract

ObjectivesHIV-infected persons experience different patterns of viral suppression after initiating combination antiretroviral therapy (cART). The relationship between such differences and risk of virological failure after starting a new antiretroviral could help with patient monitoring strategies.MethodsA total of 1827 patients on cART starting at least one new antiretroviral from 1 January 2000 while maintaining a suppressed viral load were included in the analysis. Poisson regression analysis identified factors predictive of virological failure after baseline in addition to traditional demographic variables. Baseline was defined as the date of starting new antiretrovirals.ResultsFour hundred and fifty-one patients (24.7%) experienced virological failure, with an incidence rate (IR) of 7.3 per 100 person-years of follow-up (PYFU) [95% confidence interval (CI) 6.7-8.0]. After adjustment, patients who had rebounded in the year prior to baseline had a 2.4-times higher rate of virological failure after baseline (95% CI 1.77-3.26; P <.0001), while there was no increased incidence in patients whose last viral rebound was > 3 years prior to baseline [Incidence rate ratio (IRR) 1.06; 95% CI 0.75-1.50; P=0.73] compared with patients who had never virally rebounded. Patients had an 86% (95% CI 1.36-2.55; P <.0001), 53% (95% CI 1.06-2.04; P=0.02) and 5% (95% CI 0.80-1.38; P=0.72) higher virological failure rate after baseline if they were virally suppressed < 50%, 50-70% and 70-90% of the time they were on cART prior to baseline, respectively, compared with those virally suppressed > 90% of the time.DiscussionIntensive monitoring after a treatment switch is required in patients who have rebounded recently or have a low percentage of time suppressed while on cART. Consideration should be given to increasing the provision of adherence counselling.

Type: Article
Title: History of viral suppression on combination antiretroviral therapy as a predictor of virological failure after a treatment change*
DOI: 10.1111/j.1468-1293.2009.00816.x
Keywords: virological failure, antiretroviral therapy, virological suppression, viral rebound, HIV-INFECTED PATIENTS, CLINICAL PROGRESSION, REBOUND RATES, CELL COUNT, ADHERENCE, SUCCESS, VIREMIA, NONADHERENCE, COPIES/ML, EUROSIDA
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
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Epidemiology and Health
URI: http://discovery.ucl.ac.uk/id/eprint/146943
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