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

Maria Mercedes Santoro, Daniele Armenia, Claudia Alteri, Philippe Flandre, Andrea Calcagno, Mario Santoro, Caterina Gori, Lavinia Fabeni, Rita Bellagamba, Vanni Borghi, Federica Forbici, Alessandra Latini, Guido Palamara, Raffaella Libertone, Valerio Tozzi, Evangelo Boumis, Chiara Tommasi, Carmela Pinnetti, Adriana Ammassari, Emanuele Nicastri & 9 others Annarita Buonomini, Valentina Svicher, Massimo Andreoni, Pasquale Narciso, Cristina Mussini, Andrea Antinori, Francesca Ceccherini-Silberstein, Giovanni Di Perri, Carlo Federico Perno

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: We tested whether pre-HAART viraemia affects the achievement and maintenance of virological success in HIV-1-infected patients starting modern irstline therapies. Methods: A total of 1,430 patients starting their irst 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 (irst of two consecutive viraemia values >50 copies/ml after virological success) were evaluated by Kaplan-Meier curves and Cox regression analyses. Results: 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%; P500,000 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]; P500,000 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). Conclusions: 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 signiicant population that may deserve special attention.

Original languageEnglish
Pages (from-to)867-876
Number of pages10
JournalAntiviral Therapy
Volume18
Issue number7
DOIs
Publication statusPublished - 2013

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Viremia
Highly Active Antiretroviral Therapy
Viral Load
Therapeutics
CD4 Lymphocyte Count
Drug Resistance
HIV-1
Genotype
Regression Analysis
Maintenance
T-Lymphocytes

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Santoro, M. M., Armenia, D., Alteri, C., Flandre, P., Calcagno, A., Santoro, M., ... Perno, C. F. (2013). Impact of pre-therapy viral load on virological response to modern irst-line HAART. Antiviral Therapy, 18(7), 867-876. https://doi.org/10.3851/IMP2531

Impact of pre-therapy viral load on virological response to modern irst-line HAART. / Santoro, Maria Mercedes; Armenia, Daniele; Alteri, Claudia; Flandre, Philippe; Calcagno, Andrea; Santoro, Mario; Gori, Caterina; Fabeni, Lavinia; Bellagamba, Rita; Borghi, Vanni; Forbici, Federica; Latini, Alessandra; Palamara, Guido; Libertone, Raffaella; Tozzi, Valerio; Boumis, Evangelo; Tommasi, Chiara; Pinnetti, Carmela; Ammassari, Adriana; Nicastri, Emanuele; Buonomini, Annarita; Svicher, Valentina; Andreoni, Massimo; Narciso, Pasquale; Mussini, Cristina; Antinori, Andrea; Ceccherini-Silberstein, Francesca; Perri, Giovanni Di; Perno, Carlo Federico.

In: Antiviral Therapy, Vol. 18, No. 7, 2013, p. 867-876.

Research output: Contribution to journalArticle

Santoro, MM, Armenia, D, Alteri, C, Flandre, P, Calcagno, A, Santoro, M, Gori, C, Fabeni, L, Bellagamba, R, Borghi, V, Forbici, F, Latini, A, Palamara, G, Libertone, R, Tozzi, V, Boumis, E, Tommasi, C, Pinnetti, C, Ammassari, A, Nicastri, E, Buonomini, A, Svicher, V, Andreoni, M, Narciso, P, Mussini, C, Antinori, A, Ceccherini-Silberstein, F, Perri, GD & Perno, CF 2013, 'Impact of pre-therapy viral load on virological response to modern irst-line HAART', Antiviral Therapy, vol. 18, no. 7, pp. 867-876. https://doi.org/10.3851/IMP2531
Santoro MM, Armenia D, Alteri C, Flandre P, Calcagno A, Santoro M et al. Impact of pre-therapy viral load on virological response to modern irst-line HAART. Antiviral Therapy. 2013;18(7):867-876. https://doi.org/10.3851/IMP2531
Santoro, Maria Mercedes ; Armenia, Daniele ; Alteri, Claudia ; Flandre, Philippe ; Calcagno, Andrea ; Santoro, Mario ; Gori, Caterina ; Fabeni, Lavinia ; Bellagamba, Rita ; Borghi, Vanni ; Forbici, Federica ; Latini, Alessandra ; Palamara, Guido ; Libertone, Raffaella ; Tozzi, Valerio ; Boumis, Evangelo ; Tommasi, Chiara ; Pinnetti, Carmela ; Ammassari, Adriana ; Nicastri, Emanuele ; Buonomini, Annarita ; Svicher, Valentina ; Andreoni, Massimo ; Narciso, Pasquale ; Mussini, Cristina ; Antinori, Andrea ; Ceccherini-Silberstein, Francesca ; Perri, Giovanni Di ; Perno, Carlo Federico. / Impact of pre-therapy viral load on virological response to modern irst-line HAART. In: Antiviral Therapy. 2013 ; Vol. 18, No. 7. pp. 867-876.
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abstract = "Background: We tested whether pre-HAART viraemia affects the achievement and maintenance of virological success in HIV-1-infected patients starting modern irstline therapies. Methods: A total of 1,430 patients starting their irst 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 (irst of two consecutive viraemia values >50 copies/ml after virological success) were evaluated by Kaplan-Meier curves and Cox regression analyses. Results: 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{\%}; P500,000 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]; P500,000 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). Conclusions: 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 signiicant population that may deserve special attention.",
author = "Santoro, {Maria Mercedes} and Daniele Armenia and Claudia Alteri and Philippe Flandre and Andrea Calcagno and Mario Santoro and Caterina Gori and Lavinia Fabeni and Rita Bellagamba and Vanni Borghi and Federica Forbici and Alessandra Latini and Guido Palamara and Raffaella Libertone and Valerio Tozzi and Evangelo Boumis and Chiara Tommasi and Carmela Pinnetti and Adriana Ammassari and Emanuele Nicastri and Annarita Buonomini and Valentina Svicher and Massimo Andreoni and Pasquale Narciso and Cristina Mussini and Andrea Antinori and Francesca Ceccherini-Silberstein and Perri, {Giovanni Di} and Perno, {Carlo Federico}",
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T1 - Impact of pre-therapy viral load on virological response to modern irst-line HAART

AU - Santoro, Maria Mercedes

AU - Armenia, Daniele

AU - Alteri, Claudia

AU - Flandre, Philippe

AU - Calcagno, Andrea

AU - Santoro, Mario

AU - Gori, Caterina

AU - Fabeni, Lavinia

AU - Bellagamba, Rita

AU - Borghi, Vanni

AU - Forbici, Federica

AU - Latini, Alessandra

AU - Palamara, Guido

AU - Libertone, Raffaella

AU - Tozzi, Valerio

AU - Boumis, Evangelo

AU - Tommasi, Chiara

AU - Pinnetti, Carmela

AU - Ammassari, Adriana

AU - Nicastri, Emanuele

AU - Buonomini, Annarita

AU - Svicher, Valentina

AU - Andreoni, Massimo

AU - Narciso, Pasquale

AU - Mussini, Cristina

AU - Antinori, Andrea

AU - Ceccherini-Silberstein, Francesca

AU - Perri, Giovanni Di

AU - Perno, Carlo Federico

PY - 2013

Y1 - 2013

N2 - Background: We tested whether pre-HAART viraemia affects the achievement and maintenance of virological success in HIV-1-infected patients starting modern irstline therapies. Methods: A total of 1,430 patients starting their irst 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 (irst of two consecutive viraemia values >50 copies/ml after virological success) were evaluated by Kaplan-Meier curves and Cox regression analyses. Results: 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%; P500,000 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]; P500,000 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). Conclusions: 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 signiicant population that may deserve special attention.

AB - Background: We tested whether pre-HAART viraemia affects the achievement and maintenance of virological success in HIV-1-infected patients starting modern irstline therapies. Methods: A total of 1,430 patients starting their irst 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 (irst of two consecutive viraemia values >50 copies/ml after virological success) were evaluated by Kaplan-Meier curves and Cox regression analyses. Results: 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%; P500,000 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]; P500,000 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). Conclusions: 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 signiicant population that may deserve special attention.

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