Transient detectable viremia and the risk of viral rebound in patients from the Swiss HIV Cohort Study.

Young, Jim; Rickenbach, Martin; Calmy, Alexandra; Bernasconi, Enos; Stähelin, Cornelia Johanna; Schmid, Patrick; Cavassini, Matthias; Battegay, Manuel; Günthard, Huldrych F; Bucher, Heiner C (2015). Transient detectable viremia and the risk of viral rebound in patients from the Swiss HIV Cohort Study. BMC infectious diseases, 15(1), p. 382. BioMed Central 10.1186/s12879-015-1120-8

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BACKGROUND

Temporary increases in plasma HIV RNA ('blips') are common in HIV patients on combination antiretroviral therapy (cART). Blips above 500 copies/mL have been associated with subsequent viral rebound. It is not clear if this relationship still holds when measurements are made using newer more sensitive assays.

METHODS

We selected antiretroviral-naive patients that then recorded one or more episodes of viral suppression on cART with HIV RNA measurements made using more sensitive assays (lower limit of detection below 50 copies/ml). We estimated the association in these episodes between blip magnitude and the time to viral rebound.

RESULTS

Four thousand ninety-four patients recorded a first episode of viral suppression on cART using more sensitive assays; 1672 patients recorded at least one subsequent suppression episode. Most suppression episodes (87 %) were recorded with TaqMan version 1 or 2 assays. Of the 2035 blips recorded, 84 %, 12 % and 4 % were of low (50-199 copies/mL), medium (200-499 copies/mL) and high (500-999 copies/mL) magnitude respectively. The risk of viral rebound increased as blip magnitude increased with hazard ratios of 1.20 (95 % CI 0.89-1.61), 1.42 (95 % CI 0.96-2.19) and 1.93 (95 % CI 1.24-3.01) for low, medium and high magnitude blips respectively; an increase of hazard ratio 1.09 (95 % CI 1.03 to 1.15) per 100 copies/mL of HIV RNA.

CONCLUSIONS

With the more sensitive assays now commonly used for monitoring patients, blips above 200 copies/mL are increasingly likely to lead to viral rebound and should prompt a discussion about adherence.

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