Impact of pre-therapy viral load on virological response to modern first-line HAART

We tested whether pre-HAART viraemia affects the achievement and maintenance of virological success in HIV-1-infected patients starting modern first-line therapies. A total of 1,430 patients starting their first HAART (genotype-tailored) in 2008 (median; IQR: 2006-2009) were grouped according to lev...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Antiviral therapy 2013-01, Vol.18 (7), p.867-876
Hauptverfasser: SANTORO, Maria Mercedes, ARMENIA, Daniele, FORBID, Federica, LATINI, Alessandra, PALAMARA, Guido, LIBERTONE, Raffaella, TOZZI, Valerio, BOUMIS, Evangelo, TOMMASI, Chiara, PINNETTI, Carmela, AMMASSARI, Adriana, NICASTRI, Emanuele, ALTERI, Claudia, BUONOMINI, Annarita, SVIEHER, Valentina, ANDREONI, Massimo, NARCISO, Pasquale, MUSSINI, Cristina, ANTINORI, Andrea, CECCHERINI-SILBERSTEIN, Francesco, DI PERRI, Giovanni, PERNO, Carlo Federico, FLANDRE, Philippe, CALCAGNO, Andrea, SANTORO, Mario, GORI, Caterina, FABENI, Lavinia, BELLAGAMBA, Rita, BORGHI, Vanni
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
Beschreibung
Zusammenfassung:We tested whether pre-HAART viraemia affects the achievement and maintenance of virological success in HIV-1-infected patients starting modern first-line therapies. A total of 1,430 patients starting their first HAART (genotype-tailored) in 2008 (median; IQR: 2006-2009) were grouped according to levels of pre-HAART viraemia (≤ 30,000, 30,001-100,000, 100,001-300,000, 300,001-500,000 and > 500,000 copies/ml). The impact of pre-therapy viraemia on the time to virological success (viraemia ≤ 50 copies/ml) and on the time to virological rebound (first of two consecutive viraemia values > 50 copies/ml after virological success) were evaluated by Kaplan-Meier curves and Cox regression analyses. Median pre-HAART viraemia was 5.1 log10 copies/ml (IQR 4.5-5.5), and 53% of patients had viraemia > 100,000 copies/ml. By week 48, the prevalence of patients reaching virological success was > 90% in all pre-HAART viraemia ranges, with the only exception of range > 500,000 copies/ml (virological success = 83%; P < 0.001). Higher pre-HAART viraemia was tightly correlated with longer median time to achieve virological success. Cox multivariable estimates confirmed this result: patients with pre-HAART viraemia > 500,000 copies/ml showed the lowest hazard of virological undetectability after adjusting for age, gender, pre-HAART CD4+ T-cell count, transmitted drug resistance, calendar year and third drug administered (adjusted hazard ratio [95% CI]: 0.27 [0.21, 0.35]; P < 0.001). Pre-HAART viraemia > 500,000 copies/ml was also associated with higher probability of virological rebound compared with patients belonging to lower viraemia strata at weeks 4, 12 and 24 (P = 0.050). At the time of modern HAART, and even though an average > 90% of virological success, high pre-HAART viraemia remains an independent factor associated with delayed and decreased virological success. Patients starting HAART with > 500,000 copies/ml represent a significant population that may deserve special attention.
ISSN:1359-6535
2040-2058
DOI:10.3851/IMP2531