Prevalence and Predictive Value of Intermittent Viremia With Combination HIV Therapy

摘要: ContextIn HIV-infected patients having virologic suppression (plasma HIV RNA <50 copies/mL) with antiretroviral therapy, intermittent episodes of low-level viremia have been correlated slower decay rates latently infected cells and increased levels viral evolution, but the clinical significance of these is unknown.ObjectiveTo determine if viremia have a higher risk failure (confirmed RNA >200 copies/mL).Design SettingRetrospective analysis subjects in well-characterized cohorts, the AIDS Clinical Trials Group (ACTG) 343 trial induction-maintenance therapy (August 1997 to November 1998) Merck 035 (ongoing since March 1995).PatientsTwo hundred forty-one ACTG patients, whom 101 received triple-drug therapy throughout study, a small group 13 from Merck 035 after 6 months indinavir-zidovudine-lamivudine.Main Outcome MeasuresAssociation >50 copies/mL with a subsequent measure <50 (2 consecutive plasma measures both study groups; evidence of drug resistance 7 (n = 13) long-term follow-up.ResultsIntermittent occurred 96 (40%) 241 patients of 32 (13%) had 2 consecutive values during the median 84 weeks observation (median duration first intermittent episode was 46 weeks). Of individuals receiving triple-drug therapy throughout, 29% viremia; proportion of occurring maintenance period 64% for entire cohort 68% not receiving triple-drug throughout vs 55% those who did (P .25). Intermittent viremia predict failure: 10 (10.4%) with and 20 (13.8%) 145 without virologic failure (relative risk, 0.76; 95% confidence interval [CI], 0.29-1.72). In a Cox proportional hazards model, significantly greater (hazard ratio, 1.28; CI, 0.59-2.79). Median load assessed between 24 60 using an ultrasensitive 2.5-copies/mL detection level assay 23 vs <2.5 copies/mL .15). assessed after 76 260 (using detection level assay) and associated steady state replication .03), over 4.5 years observation. Viral DNA sequences show evolution drug resistance.ConclusionsIntermittent frequently higher levels (Merck 035), failure in initial combination indinavir-zidovudine-lamivudine (ACTG 035). In this population, treatment changes may be necessary maintain long-term low-level or intermittent viremia.