UCL logo

UCL Discovery

UCL home » Library Services » Electronic resources » UCL Discovery

Early virological response to HIV treatment: can we predict who is likely to experience subsequent treatment failure? Results from an observational cohort study, London, UK

Brima, N; Lampe, FC; Copas, A; Gilson, R; Williams, I; Johnson, MA; Phillips, AN; (2017) Early virological response to HIV treatment: can we predict who is likely to experience subsequent treatment failure? Results from an observational cohort study, London, UK. Journal Of The International Aids Society , 20 (ARTN 215) 10.7448/IAS.20.1.21567.

[img] Text
21567-31754-1-PB.pdf - ["content_typename_Published version" not defined]
Access restricted to UCL open access staff until 14 March 2018.

Download (196kB)

Abstract

Abstract Introduction: For people living with HIV, the first antiretroviral treatment (ART) regimen offers the best chance for a good virological response. Early identification of those unlikely to respond to first-line ART could enable timely intervention and increase chances of a good initial treatment response. In this study we assess the extent to which the HIV RNA viral load (VL) at 1 and 3 months is predictive of first-line treatment outcome at 6 months. Methods: All previously ART-naive individuals starting ART at two London centres since 2000 with baseline (−180 to 3 days) VL >500 c/mL had a VL measurement between 6 and 12 months after starting ART, and at least one at month 1 (4–60 days) or month 3 (61–120 days) were included. Lack of treatment response was defined as (i) VL >200 copies/mL at 6 months or (ii) VL >200 copies/mL at 6 months or simultaneous switch in drugs from at least two different drug classes before 6 months. The association with VL measurements at 1 and 3 months post-ART; change from pre-ART in these values; and CD4 count measurements at 1 and 3 months were assessed using logistic regression models. The relative fit of the models was compared using the Akaike information criterion (AIC). Results: A total of 198 out of 3258 individuals (6%) experienced lack of treatment response at 6 months (definition i), increasing to 511 (16%) for definition (ii). Those with a 1-month (day 4–60 window) VL of <1000, 1000–9999, 10,000–99,999 and >100,000 copies/ml had a 4%, 8%, 23% and 24% chance, respectively, of subsequently experiencing treatment non-response at 6 months (definition (i)). When considering the 3-month (day 61–120 window) VL, the chances of subsequently experiencing treatment non-response were, respectively, 3%, 25%, 67% and 75%. Results were similar for definition (ii). Conclusions: Whilst 3-month VL provides good discrimination between low and high risk of treatment failure, 1-month VL does not. Presence of a VL >10,000 copies/ml after 3 months of ART is a cutoff above which individuals are at a sufficiently higher risk of non-response that they may be considered for intervention.

Type: Article
Title: Early virological response to HIV treatment: can we predict who is likely to experience subsequent treatment failure? Results from an observational cohort study, London, UK
DOI: 10.7448/IAS.20.1.21567
Publisher version: http://doi.org/10.7448/IAS.20.1.21567
Language: English
Additional information: This is an Open Access article distributed under the terms of the CreativeCommons Attribution 3.0 Unported (CC BY 3.0) License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Science & Technology, Life Sciences & Biomedicine, Immunology, Infectious Diseases, initial virological response, HIV, ART, response to ART, HIV treatment, VL response to ART, PROTEASE INHIBITOR THERAPY, ANTIRETROVIRAL THERAPY
UCL classification: UCL > School of Life and Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health Care > Infection and Population Health
URI: http://discovery.ucl.ac.uk/id/eprint/1573417
Downloads since deposit
1Download
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item