How relevant is the HIV low level viremia and how is its management changing in the era of modern ART? A large cohort analysis
Copyright © 2019 Elsevier B.V. All rights reserved..
BACKGROUND: It is still unclear what might be the best management of people living with HIV (PLWHIV) with low level viremia (LLV) despite being on antiretroviral treatment (ART).
OBJECTIVES: Aim of our study is to describe the clinical management of PLWHIV with LLV followed in a large cohort.
STUDY DESIGN: Retrospective cohort study.
RESULTS: We included 1607 adult patients over a three-year period (2015-2017). Follow up continued until June, 30th 2019 or last available visit. We observed a low incidence of LLV (0.9 % in 2015, 0.7 % in 2016 and 0.4 % in 2017), with a total of 21 patients with persistent LLV (pLLV), i.e. two consecutive HIV-RNA determinations of 50-500 copies/ml after at least 4 months of viral suppression. Among them, 12 had low compliance to treatment. Genotype resistance test (GRT) was performed in 14 patients and demonstrated at least one resistance mutation in 85.7 %. We described three categories of patients with pLLV: i) those whose ART regimen was not adequate based on GRT; ii) those with presumed suboptimal drug exposure, consequence of low adherence and/or drug-drug interactions and iii) those in which pLLV remained unexplained. For the first two categories, optimization or intensification of ART regimen led to viral suppression in >80 % of patients. We observed only 2 (9.5 %) virological failures and 1 (4.8 %) persistence of LLV in patients who did not switch ART.
CONCLUSIONS: In our cohort, the rate of LLV showed a decline in most recent years. Adherence and previous GRT should be carefully considered with the aim of further reducing the phenomenon.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2020 |
|---|---|
| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:123 |
|---|---|
| Enthalten in: |
Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology - 123(2020) vom: 01. Feb., Seite 104255 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Taramasso, Lucia [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Anti-HIV Agents |
|---|
| Anmerkungen: |
Date Completed 14.05.2021 Date Revised 14.05.2021 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.jcv.2019.104255 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM305258397 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM305258397 | ||
| 003 | DE-627 | ||
| 005 | 20231225120802.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2020 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.jcv.2019.104255 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1017.xml |
| 035 | |a (DE-627)NLM305258397 | ||
| 035 | |a (NLM)31927152 | ||
| 035 | |a (PII)S1386-6532(19)30285-9 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Taramasso, Lucia |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a How relevant is the HIV low level viremia and how is its management changing in the era of modern ART? A large cohort analysis |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 14.05.2021 | ||
| 500 | |a Date Revised 14.05.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2019 Elsevier B.V. All rights reserved. | ||
| 520 | |a BACKGROUND: It is still unclear what might be the best management of people living with HIV (PLWHIV) with low level viremia (LLV) despite being on antiretroviral treatment (ART) | ||
| 520 | |a OBJECTIVES: Aim of our study is to describe the clinical management of PLWHIV with LLV followed in a large cohort | ||
| 520 | |a STUDY DESIGN: Retrospective cohort study | ||
| 520 | |a RESULTS: We included 1607 adult patients over a three-year period (2015-2017). Follow up continued until June, 30th 2019 or last available visit. We observed a low incidence of LLV (0.9 % in 2015, 0.7 % in 2016 and 0.4 % in 2017), with a total of 21 patients with persistent LLV (pLLV), i.e. two consecutive HIV-RNA determinations of 50-500 copies/ml after at least 4 months of viral suppression. Among them, 12 had low compliance to treatment. Genotype resistance test (GRT) was performed in 14 patients and demonstrated at least one resistance mutation in 85.7 %. We described three categories of patients with pLLV: i) those whose ART regimen was not adequate based on GRT; ii) those with presumed suboptimal drug exposure, consequence of low adherence and/or drug-drug interactions and iii) those in which pLLV remained unexplained. For the first two categories, optimization or intensification of ART regimen led to viral suppression in >80 % of patients. We observed only 2 (9.5 %) virological failures and 1 (4.8 %) persistence of LLV in patients who did not switch ART | ||
| 520 | |a CONCLUSIONS: In our cohort, the rate of LLV showed a decline in most recent years. Adherence and previous GRT should be carefully considered with the aim of further reducing the phenomenon | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Drug resistance mutations | |
| 650 | 4 | |a GRT | |
| 650 | 4 | |a HIV reservoir | |
| 650 | 4 | |a Low level viremia | |
| 650 | 4 | |a Residual viremia | |
| 650 | 4 | |a Virological failure | |
| 650 | 7 | |a Anti-HIV Agents |2 NLM | |
| 650 | 7 | |a RNA, Viral |2 NLM | |
| 700 | 1 | |a Magnasco, Laura |e verfasserin |4 aut | |
| 700 | 1 | |a Bruzzone, Bianca |e verfasserin |4 aut | |
| 700 | 1 | |a Caligiuri, Patrizia |e verfasserin |4 aut | |
| 700 | 1 | |a Bozzi, Giorgio |e verfasserin |4 aut | |
| 700 | 1 | |a Mora, Sara |e verfasserin |4 aut | |
| 700 | 1 | |a Balletto, Elisa |e verfasserin |4 aut | |
| 700 | 1 | |a Tatarelli, Paola |e verfasserin |4 aut | |
| 700 | 1 | |a Giacomini, Mauro |e verfasserin |4 aut | |
| 700 | 1 | |a Di Biagio, Antonio |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology |d 1997 |g 123(2020) vom: 01. Feb., Seite 104255 |w (DE-627)NLM097223964 |x 1873-5967 |7 nnns |
| 773 | 1 | 8 | |g volume:123 |g year:2020 |g day:01 |g month:02 |g pages:104255 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.jcv.2019.104255 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 123 |j 2020 |b 01 |c 02 |h 104255 | ||