Background: There are conflicting data regarding baseline determinants of virological non-suppression outcomes in persons with HIV who initiate antiretroviral treatment (ART). We evaluated the impact of different baseline variables in the RESPOND cohort. Methods: We included treatment-naïve participants aged ≥18 who initiated 3-drug ART, in 2014-2020. We assessed the odds of virological suppression (VS) at weeks 48 and 96 using logistic regression. Viral blips, low-level viremia (LLV), residual viremia (RV) and virological failure (VF) rates were assessed using Cox regression. Results: Out of 4,310 eligible participants, 72% initiated integrase strand transfer inhibitor (INSTI)-based regimens. At 48 and 96 weeks, 91·0% and 93·3% achieved VS, respectively. At 48 weeks, Kaplan-Meier estimates of rates of viral blips were 9·6%, LLV 2·1%, RV 22·2% and VF 2·1%. Baseline HIV-1 RNA >100,000 copies/mL and CD4+ count ≤200 cells/µL were negatively associated with VS at weeks 48 (aOR 0·51; 95%CI:0·39-0·68 and 0·40; 95%CI:0·27-0·58, respectively) and 96, and with significantly higher rates of blips, LLV and RV. CD4+ counts ≤200 cells/µL were associated with higher risk of VF (aHR 3·12; 95%CI:2·02-4·83). Results were consistent in those starting INSTIs versus other regimens and those initiating dolutegravir versus other INSTIs. Conclusions: Initial high HIV-1 RNA and low CD4+ counts are associated with lower rates of VS at 48 and 96 weeks and higher rates of viral blips, LLV and RV. Low baseline CD4+ counts are associated with higher VF rates.These associations remain with INSTI- and specifically dolutegravir-based regimens. These findings suggest that the impact of these baseline determinants is independent of the ART regimen initiated.

Plasma HIV-1 RNA and CD4+ T-cell counts are determinants of virological non-suppression outcomes with initial integrase inhibitor-based regimens: A prospective RESPOND cohort study / Álvarez, Hortensia; Mocroft, Amanda; Ryom, Lene; Neesgaard, Bastian; Edwards, Simon; Svedhem, Vero-Nica; Günthard, Huldrych F; Zangerle, Robert; Smith, Colette; Castagna, Antonella; D Arminio Monforte, Antonella; Wit, Ferdinand; Stecher, Melanie; Lehman, Clara; Mussini, Cristina; Fontas, Eric; González, Eva; Wasmuth, Jan-Christian; Sönnerborg, Anders; De Wit, Stéphane; Chkhartishvili, Nikoloz; Stephan, Christoph; Petoumenos, Kathy; Jaschinski, Nadine; Vannappagari, Vani; Gallant, Joel; Young, Lital; Volny Anne, Alain; Greenberg, Lauren; Martín-Iguacel, Raquel; Poveda, Eva; Llibre, Josep M. - In: CLINICAL INFECTIOUS DISEASES. - ISSN 1058-4838. - 77:4(2023), pp. 593-605. [10.1093/cid/ciad219]

Plasma HIV-1 RNA and CD4+ T-cell counts are determinants of virological non-suppression outcomes with initial integrase inhibitor-based regimens: A prospective RESPOND cohort study

Mussini, Cristina;
2023

Abstract

Background: There are conflicting data regarding baseline determinants of virological non-suppression outcomes in persons with HIV who initiate antiretroviral treatment (ART). We evaluated the impact of different baseline variables in the RESPOND cohort. Methods: We included treatment-naïve participants aged ≥18 who initiated 3-drug ART, in 2014-2020. We assessed the odds of virological suppression (VS) at weeks 48 and 96 using logistic regression. Viral blips, low-level viremia (LLV), residual viremia (RV) and virological failure (VF) rates were assessed using Cox regression. Results: Out of 4,310 eligible participants, 72% initiated integrase strand transfer inhibitor (INSTI)-based regimens. At 48 and 96 weeks, 91·0% and 93·3% achieved VS, respectively. At 48 weeks, Kaplan-Meier estimates of rates of viral blips were 9·6%, LLV 2·1%, RV 22·2% and VF 2·1%. Baseline HIV-1 RNA >100,000 copies/mL and CD4+ count ≤200 cells/µL were negatively associated with VS at weeks 48 (aOR 0·51; 95%CI:0·39-0·68 and 0·40; 95%CI:0·27-0·58, respectively) and 96, and with significantly higher rates of blips, LLV and RV. CD4+ counts ≤200 cells/µL were associated with higher risk of VF (aHR 3·12; 95%CI:2·02-4·83). Results were consistent in those starting INSTIs versus other regimens and those initiating dolutegravir versus other INSTIs. Conclusions: Initial high HIV-1 RNA and low CD4+ counts are associated with lower rates of VS at 48 and 96 weeks and higher rates of viral blips, LLV and RV. Low baseline CD4+ counts are associated with higher VF rates.These associations remain with INSTI- and specifically dolutegravir-based regimens. These findings suggest that the impact of these baseline determinants is independent of the ART regimen initiated.
2023
77
4
593
605
Plasma HIV-1 RNA and CD4+ T-cell counts are determinants of virological non-suppression outcomes with initial integrase inhibitor-based regimens: A prospective RESPOND cohort study / Álvarez, Hortensia; Mocroft, Amanda; Ryom, Lene; Neesgaard, Bastian; Edwards, Simon; Svedhem, Vero-Nica; Günthard, Huldrych F; Zangerle, Robert; Smith, Colette; Castagna, Antonella; D Arminio Monforte, Antonella; Wit, Ferdinand; Stecher, Melanie; Lehman, Clara; Mussini, Cristina; Fontas, Eric; González, Eva; Wasmuth, Jan-Christian; Sönnerborg, Anders; De Wit, Stéphane; Chkhartishvili, Nikoloz; Stephan, Christoph; Petoumenos, Kathy; Jaschinski, Nadine; Vannappagari, Vani; Gallant, Joel; Young, Lital; Volny Anne, Alain; Greenberg, Lauren; Martín-Iguacel, Raquel; Poveda, Eva; Llibre, Josep M. - In: CLINICAL INFECTIOUS DISEASES. - ISSN 1058-4838. - 77:4(2023), pp. 593-605. [10.1093/cid/ciad219]
Álvarez, Hortensia; Mocroft, Amanda; Ryom, Lene; Neesgaard, Bastian; Edwards, Simon; Svedhem, Vero-Nica; Günthard, Huldrych F; Zangerle, Robert; Smith, Colette; Castagna, Antonella; D Arminio Monforte, Antonella; Wit, Ferdinand; Stecher, Melanie; Lehman, Clara; Mussini, Cristina; Fontas, Eric; González, Eva; Wasmuth, Jan-Christian; Sönnerborg, Anders; De Wit, Stéphane; Chkhartishvili, Nikoloz; Stephan, Christoph; Petoumenos, Kathy; Jaschinski, Nadine; Vannappagari, Vani; Gallant, Joel; Young, Lital; Volny Anne, Alain; Greenberg, Lauren; Martín-Iguacel, Raquel; Poveda, Eva; Llibre, Josep M
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1302547
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