Factors associated with HIV RNA viral loads in ART-naïve patients: implications for treatment as prevention in concentrated epidemics

Rangarajan, Suresh; Colby, Donn J.; Truong, Giang; Huu, Hung Nguyen; Thu, Van Tieu Thi; Quoc, Binh Luong; Broh, Tou Plui; Tri, Danh Tran; Giang, Dao Duc; Chen, Mario; Zeng, Yanwu; West, Gary R.

doi:10.1016/s2055-6640(20)30689-0

Cited by 5 publications

(3 citation statements)

References 31 publications

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“…Consistent with findings from previous reports [ 11 – 13 ], our study found that males were more likely to have a high VL at ART initiation than female patients. Women tend to present earlier for care compared to men and a later presentation for ART initiation could contribute to differences in VL at presentation.…”

Section: Discussionsupporting

confidence: 93%

“…Patients in our cohort with a positive antibody against HCV were less likely to have a high VL (OR = 0.49, 95% CI = 0.30–0.79). An inverse association between HIV VL and HCV status was also found in a cross-sectional study of HIV-infected Vietnamese patients who did not meet criteria for ART [ 13 ]. Studies of HBV and HCV co-infection have suggested the possibility of a reciprocal interaction between HCV infection and HBV infection [ 49 – 51 ].…”

Section: Discussionmentioning

confidence: 87%

“…A number of factors may be associated with the plasma HIV VL in untreated patients. Higher levels of HIV VL have been found in patients who are male [ 11 – 13 ], older age [ 14 ], and among those expressing certain HLA subtypes [ 15 , 16 ]. HIV VL is significantly higher during acute HIV infection and during late stage AIDS when the CD4 cell count is <50 cells/mm 3 [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Cigarette smoking is associated with high HIV viral load among adults presenting for antiretroviral therapy in Vietnam

et al. 2017

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High HIV viral load (VL >100,000 cp/ml) is associated with increased HIV transmission risk, faster progression to AIDS, and reduced response to some antiretroviral regimens. To better understand factors associated with high VL, we examined characteristics of patients presenting for treatment in Hanoi, Vietnam. We examined baseline data from the Viral Load Monitoring in Vietnam Study, a randomized controlled trial of routine VL monitoring in a population starting antiretroviral therapy (ART) at a clinic in Hanoi. Patients with prior treatment failure or ART resistance were excluded. Characteristics examined included demographics, clinical and laboratory data, and substance use. Logistic regression was used to calculate crude and adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Out of 636 patients, 62.7% were male, 72.9% were ≥30 years old, and 28.3% had a history of drug injection. Median CD4 was 132 cells/mm3, and 34.9% were clinical stage IV. Active cigarette smoking was reported by 36.3% with 14.0% smoking >10 cigarettes per day. Alcohol consumption was reported by 20.1% with 6.1% having ≥5 drinks per event. Overall 53.0% had a VL >100,000 cp/ml. Male gender, low body weight, low CD4 count, prior TB, and cigarette smoking were associated with high VL. Those who smoked 1–10 cigarettes per day were more likely to have high VL (aOR = 1.99, 95% CI = 1.15–3.45), while the smaller number of patients who smoked >10 cigarettes per day had a non-significant trend toward higher VL (aOR = 1.41, 95% CI = 0.75–2.66). Alcohol consumption was not significantly associated with high VL. Tobacco use is increasingly recognized as a contributor to premature morbidity and mortality among HIV-infected patients. In our study, cigarette smoking in the last 30 days was associated with a 1.5 to 2-fold higher odds of having an HIV VL >100,000 cp/ml among patients presenting for ART. These findings provide further evidence of the negative effects of tobacco use among HIV-infected patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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Cigarette smoking is associated with high HIV viral load among adults presenting for antiretroviral therapy in Vietnam

et al. 2017

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Prevalence and incidence of hepatitis C virus infection in men who have sex with men: a systematic review and meta-analysis

Jin

Dore

Matthews

et al. 2021

The Lancet Gastroenterology & Hepatology

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Virologic Outcomes Among People Living With Human Immunodeficiency Virus With High Pretherapy Viral Load Burden Initiating on Common Core Agents

Mills¹,

Schulman²,

Fusco³

et al. 2021

Open Forum Infectious Diseases

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Background People living with HIV (PLWH) initiating antiretroviral therapy (ART) with viral loads (VL) ≥100,000 copies/mL are less likely to achieve virologic success, but few studies have characterized real-world treatment outcomes. Methods ART-naïve PLWH with VLs ≥100,000 copies/mL initiating dolutegravir (DTG), elvitegravir (EVG), raltegravir (RAL) or darunavir (DRV) between 12Aug2013 and 31July2017 were identified from the OPERA Database. Virologic failure was defined as (i) 2 consecutive VLs ≥200 copies/mL after 36 weeks of ART, or (ii) 1 VL ≥200 copies/mL with core agent discontinuation after 36 weeks, or (iii) 2 consecutive VL ≥200 copies/mL after suppression (≤50 copies/mL) before 36 weeks, or (iv) 1 VL ≥200 copies/mL with discontinuation after suppression before 36 weeks. Cox modelling estimated the association between regimen and virologic failure. Results There were 2,038 ART-naïve patients with high VL who initiated DTG (36%), EVG (46%), DRV (16%) or RAL (2%). Median follow-up was 18.1 months (IQR:12.4-28.9). EVG and DTG initiators were similar at baseline but RAL initiators were older and more likely to be female with low CD4 cell counts while DRV initiators differed notably on factors associated with treatment failure. Virologic failure was experienced by 9.2% DTG, 13.2% EVG, 18.4% RAL and 18.8% DRV initiators. Compared to DTG, the adjusted hazard ratio (95% CI) was 1.46 (1.05, 2.03) for EVG, 2.24 (1.50, 3.34) for DRV, and 4.13 (1.85, 9.24) for RAL. Conclusion ART-naïve PLWH with high VLs initiating on DTG were significantly less likely to experience virologic failure compared to EVG, RAL and DRV initiators.

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Factors associated with HIV RNA viral loads in ART-naïve patients: implications for treatment as prevention in concentrated epidemics

Cited by 5 publications

References 31 publications

Cigarette smoking is associated with high HIV viral load among adults presenting for antiretroviral therapy in Vietnam

Cigarette smoking is associated with high HIV viral load among adults presenting for antiretroviral therapy in Vietnam

Prevalence and incidence of hepatitis C virus infection in men who have sex with men: a systematic review and meta-analysis

Virologic Outcomes Among People Living With Human Immunodeficiency Virus With High Pretherapy Viral Load Burden Initiating on Common Core Agents

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