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 NicastriAnnarita Buonomini, Valentina Svicher, Massimo Andreoni, Pasquale Narciso, Cristina Mussini, Andrea Antinori, Francesca Ceccherini-Silberstein, Giovanni Di Perri, Carlo Federico Perno

Research output: Contribution to journalArticlepeer-review


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
Issue number7
Publication statusPublished - 2013

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases


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