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Very high pre-therapy viral load is a predictor of virological rebound in HIV-1-infected patients starting a modern first-line regimen

Armenia, D; Di Carlo, D; Cozzi-Lepri, A; Calcagno, A; Borghi, V; Gori, C; Bertoli, A; ... ICONA Foundation Study Group, ; + view all (2019) Very high pre-therapy viral load is a predictor of virological rebound in HIV-1-infected patients starting a modern first-line regimen. Antiviral Therapy 10.3851/IMP3309. (In press). Green open access

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Abstract

BACKGROUND: Pre-cART (combined antiretroviral therapy) plasma viral load >500,000 copies/mL has been associated with a lower probability of achieving virological suppression, while few data about its role on maintenance of virological suppression are available. In this study we aimed to clarify whether high levels of pre-cART viremia are associated with virological rebound (VR) after virological suppression. METHODS: HIV-infected individuals who achieved virological suppression after first-line cART were included. VR was defined as the first of two consecutive viremia >50 copies/mL (VR50) or, in an alternative analysis, >200 copies/mL (VR200). The impact of pre-cART viremia on the risk of VR was evaluated by survival analyses. RESULTS: Among 5,766 patients included, 59.2%, 31.4%, 5.2% and 4.2% had pre-cART viremia ≤100,000, 100,001-500,000, 500,001-1,000,000, and >1,000,000 copies/mL, respectively. CONCLUSIONS: Pre-cART plasma viral load levels >500,000 copies/mL can identify fragile patients with poorer chance of maintaining virological control after an initial response. An effort in defining effective treatment strategies is mandatory for these patients that remain difficult to treat.

Type: Article
Title: Very high pre-therapy viral load is a predictor of virological rebound in HIV-1-infected patients starting a modern first-line regimen
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.3851/IMP3309
Publisher version: https://doi.org/10.3851/IMP3309
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
UCL classification: UCL
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 Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/10073546
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