Long-term durability of HIV viral load suppression

Dharan, Nila; Cooper, David A.

doi:10.1016/s2352-3018(17)30063-2

Cited by 5 publications

(4 citation statements)

References 12 publications

(12 reference statements)

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“…Non-MSM groups were also at higher risk of these events, with particularly strong associations for IDUs as found previously [14]. Rates of virological failure among non-white and non-MSM individuals may vary between countries and healthcare settings, but these findings reinforce the need to identify subpopulations with worse outcomes on ART [15] and understand the underlying causes. Both ethnicity and mode of acquisition are associated with social and economic factors which themselves may vary between cohorts.…”

Section: Discussionsupporting

confidence: 65%

Long-term virological suppression on first-line efavirenz + tenofovir + emtricitabine/lamivudine for HIV-1

Antinori

2019

Aids

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Objectives:Evaluate long-term rates of virological failure and treatment interruption for people living with HIV (PLWHIV) with viral suppression on first-line efavirenz + tenofovir disoproxil fumarate + emtricitabine/lamivudine (EFV + TDF + FTC/3TC), and compare these according to patient characteristics.Methods:PLWHIV enrolled in the Collaboration of Observational HIV Epidemiological Research Europe cohort collaboration, who started first-line EFV + TDF + FTC/3TC at age at least 16 years and had viral suppression (<200 copies/ml) within 9 months were included. Rates of virological failure (≥200 copies/ml) and (complete) treatment interruption were estimated according to years since initial suppression. We used Poisson regression to examine associations of baseline characteristics with rates of virological failure or treatment interruption.Results:Among 19 527 eligible PLWHIV with median (interquartile range) follow-up 3.7 (2.0–5.6) years after initial viral suppression, the estimated rate of the combined incidence of virological failure or treatment interruption fell from 9.0/100 person-years in the first year to less than 4/100 person-years beyond 3 years from suppression; considering only those remaining on EFV + TDF + FTC/3TC, the combined rate dropped from 8.2/100 person-years in the first year to less than 3.5/100 person-years beyond 3 years. PLWHIV with injecting drug-related or heterosexual transmission were at higher risk of virological failure or treatment interruption, as were those of Black ethnicity. PLWHIV aged less than 35 years were at higher risk of virological failure and treatment interruption.Conclusion:PLWHIV starting first-line EFV + TDF + FTC/3TC had low rates of virological failure and treatment interruption up to 10 years from initial suppression. Demographic characteristics can be used to identify subpopulations with higher risks of these outcomes.

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Section: Discussionsupporting

confidence: 65%

Long-term virological suppression on first-line efavirenz + tenofovir + emtricitabine/lamivudine for HIV-1

Antinori

2019

Aids

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“…26,29,46 Studies in higher-income countries, where the incidence of viraemia is lower, have found that vulnerable and disadvantaged populations are more likely to present with viraemia. 47 Burch et al found an association between viraemia and poor socio-economic circumstances, including unemployment, lack of university education, financial constraints and lack of stable housing in a British patient population. 48 None of these associations were demonstrated in our study.…”

Section: Discussionmentioning

confidence: 99%

HIV viraemia during pregnancy in women receiving preconception antiretroviral therapy in KwaDukuza, KwaZulu-Natal

Ntlantsana

Hift

Mphatswe

2019

South. Afr. j. HIV med.

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Background: Preconception antiretroviral therapy (PCART) followed by sustained viral suppression is effective in preventing mother-to-child transmission of HIV. The rates of persistent and transient viraemia in such patients have not been prospectively assessed in South Africa.Objectives: We determined the prevalence of transient and persistent viraemia in HIV-positive women entering antenatal care on PCART and studied variables associated with viraemia.Methods: We performed a prospective cross-sectional observational study of HIV-positive pregnant women presenting to a primary healthcare facility in KwaZulu-Natal. All had received at least 6 months of first-line PCART. Viral load (VL) was measured, patients were interviewed, adherence estimated using a visual analogue scale and adherence counselling provided. Viral load was repeated after 4 weeks where baseline VL exceeded 50 copies/mL.Results: We enrolled 82 participants. Of them, 59 (72%) pregnancies were unplanned. Fifteen participants (18.3%) were viraemic at presentation with VL > 50 copies/mL. Of these, seven (8.5%) had viral suppression (VL < 50 copies/mL), and eight remained viraemic at the second visit. Adherence correlated significantly with viraemia at baseline. Level of knowledge correlated with adherence but not with lack of viral suppression at baseline. Socio-economic indicators did not correlate with viraemia. No instances of vertical transmission were observed at birth.Conclusions: Approximately 20% of women receiving PCART may demonstrate viraemia. Half of these may be transient. Poor adherence is associated with viraemia, and efforts to encourage and monitor adherence are essential. The rate of unplanned pregnancies is high, and antiretroviral therapy programmes should focus on family planning needs of women in the reproductive age group to prevent viral non-suppression prior to pregnancy.Keywords: Preconception Antiretroviral Therapy; HIV; Viraemia; Antenatal Care; Adherence.

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“…For the majority of persons with human immunodeficiency virus (PWH), antiretroviral therapy (ART) suppresses HIV-1 RNA to below the level of commercial assay detection 1 – 5 . However, a subset of PWH demonstrate persistent low-level viremia while on ART 6 , 7 , a condition that not only represents a clinical conundrum for the clinician but can lead to substantial stigma and distress for the patient.…”

Section: Mainmentioning

confidence: 99%

Viral and host mediators of non-suppressible HIV-1 viremia

Mohammadi,

Etemad,

Zhang

et al. 2023

Nat Med

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Non-suppressible HIV-1 viremia (NSV) is defined as persistent low-level viremia on antiretroviral therapy (ART) without evidence of ART non-adherence or significant drug resistance. Unraveling the mechanisms behind NSV would broaden our understanding of HIV-1 persistence. Here we analyzed plasma virus sequences in eight ART-treated individuals with NSV (88% male) and show that they are composed of large clones without evidence of viral evolution over time in those with longitudinal samples. We defined proviruses that match plasma HIV-1 RNA sequences as ‘producer proviruses’, and those that did not as ‘non-producer proviruses’. Non-suppressible viremia arose from expanded clones of producer proviruses that were significantly larger than the genome-intact proviral reservoir of ART-suppressed individuals. Integration sites of producer proviruses were enriched in proximity to the activating H3K36me3 epigenetic mark. CD4+ T cells from participants with NSV demonstrated upregulation of anti-apoptotic genes and downregulation of pro-apoptotic and type I/II interferon-related pathways. Furthermore, participants with NSV showed significantly lower HIV-specific CD8+ T cell responses compared with untreated viremic controllers with similar viral loads. We identified potential critical host and viral mediators of NSV that may represent targets to disrupt HIV-1 persistence.

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Long-term durability of HIV viral load suppression

Cited by 5 publications

References 12 publications

Long-term virological suppression on first-line efavirenz + tenofovir + emtricitabine/lamivudine for HIV-1

Long-term virological suppression on first-line efavirenz + tenofovir + emtricitabine/lamivudine for HIV-1

HIV viraemia during pregnancy in women receiving preconception antiretroviral therapy in KwaDukuza, KwaZulu-Natal

Viral and host mediators of non-suppressible HIV-1 viremia

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