Intermittent HIV-1 Viremia (Blips) and Drug Resistance in Patients Receiving HAART

Abstract

REATMENT OF HUMAN IMMUNOdeficiency virus type 1 (HIV-1) infection with highly active antiretroviral therapy (HAART) can suppress viremia to below the limit of detection of available clinical assays. 1-3 The current goal of antiretroviral therapy is suppression of viremia to below 50 copies/mL of HIV-1 RNA, the limit of detection of the most sensitive available clinical assay. 4,5 Suppression to this level is necessary to prevent drug resistance, the major cause of treatment failure. 6,7 After achieving suppression, many patients experience intermittent episodes of detectable viremia ("blips"). 8-16 Blips may raise concern that resistance is developing and complicate management by increasing patient anxiety, triggering costly repeat measurements of viral load, and generating uncertainty re

HIV-1 viral load monitoring: an opportunity to reinforce treatment adherence in a resource-limited setting in Thailand

“…The causation and significance of VL in the range >50 to <1000 copies/ml are debated 9 and the concept of 'blips' (transient low-level viremia without clinical consequences) complicates the picture. 11,12 Similar numbers of blips could plausibly be expected to occur at the time of the first, second and third VL, but among our patients 23% had low detectable VL on their first test and only 6% developed detectable VL later. Opportunistic infections can result in transient increases in VL, 8,13 but at the time of VL testing, only two patients had ongoing opportunistic infections (CMV retinitis and extra-pulmonary TB).…”

Viraemia and HIV-1 drug resistance mutations among patients receiving antiretroviral treatment in Mozambique

“…This suggests that in the 81% of patients with a detectable viral load but no apparent mutations, adherence was inadequate for some reason, leading to a real risk that these patients would develop drug resistance over time. Even if we assumed that viral loads of under 1000 copies/ml might be related to ''blips'' (transient viraemia that returns spontaneously to undetectable levels without apparent clinical consequences, 14,15 ) there were only five (33%) of 15 patients with viral load titres ≥1000 copies/ml who had clinical and/or immunological signs suggesting failure. This implies that routine clinical examinations, pill-count monitoring, immunological and other existing forms of adherence monitoring would still miss the great majority of patients having inadequate viral suppression.…”

Advances in the Decision Making for Treatments of Chronic Patients Using Fuzzy Logic and Data Mining Techniques

“…Firstly, some blips may be associated to biological variability and test variability (±0.5 log 10 ) (Bryan et al, 2011). Although some studies associate blips occurrences with a higher frequency of relapse (Greub et al, 2002), most studies have confirmed that blips do not result in increased risk of virologic or clinical failure (García-Gasco et al, 2008), (Nettles et al, 2005).…”