Predictors of incomplete viral response and virologic failure in patients with acute and early HIV infection. Results of Italian Network of ACuTe HIV InfectiON (INACTION) cohort: HIV Medicine

L. Taramasso, M. Fabbiani, S. Nozza, I. De Benedetto, E. Bruzzesi, A. Mastrangelo, C. Pinnetti, A. Calcagno, M. Ferrara, G. Bozzi, E. Focà, E. Quiros-Roldan, D. Ripamonti, M. Campus, B.M. Celesia, C. Torti, L. Cosco, A. Di Biagio, S. Rusconi, G. MarchettiC. Mussini, R. Gulminetti, A. Cingolani, G. d’Ettorre, G. Madeddu, A. Franco, G. Orofino, N. Squillace, A. Muscatello, A. Gori, A. Antinori, G. Tambussi, A. Bandera

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: The aim of this study was to evaluate the factors that can influence an incomplete viral response (IVR) after acute and early HIV infection (AEHI). Methods: This was a retrospective, observational study including patients with AEHI (Fiebig stages I–V) diagnosed between January 2008 and December 2014 at 20 Italian centres. IVR was defined by: (1) viral blip (51–1000 HIV-1 RNA copies/mL after achievement of  1000 copies/mL after achievement of  50 copies/mL after 48 weeks on ART or two consecutive HIV-1 RNA levels with ascending trend during ART). Cox regression analysis was used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for IVR. Results: In all, 263 patients were studied, 227 (86%) males, with a median [interquartile range (IQR)] age of 38 (30–46) years. During a median follow-up of 13.0 (5.7–31.1) months, 38 (14.4%) had IVR. The presence of central nervous system (CNS) symptoms was linked to a higher risk of IVR (HR = 4.70, 95% CI: 1.56–14.17), while a higher CD4/CD8 cell count ratio (HR = 0.13, 95% CI: 0.03–0.51 for each point increase) and first-line ART with three-drug regimens recommended by current guidelines (HR = 0.40, 95% CI: 0.18–0.91 compared with other regimens including four or five drugs, older drugs or non-standard backbones) were protective against IVR. Conclusions: Patients with lower CD4/CD8 ratio and CNS symptoms could be at a higher risk of IVR after AEHI. The use of recommended ART may be relevant for improving short-term viral efficacy in this group of patients. © 2020 British HIV Association
Original languageEnglish
Pages (from-to)523-535
Number of pages13
JournalHIV Med.
Volume21
Issue number8
DOIs
Publication statusPublished - 2020

Keywords

  • acute HIV infection
  • blip
  • early antiretroviral treatment
  • incomplete viral response
  • virologic failure
  • abacavir plus lamivudine
  • atazanavir
  • CD4 antigen
  • CD8 antigen
  • cobicistat
  • darunavir
  • dolutegravir
  • elvitegravir
  • emtricitabine plus tenofovir alafenamide
  • raltegravir
  • rilpivirine
  • ritonavir
  • tenofovir disoproxil
  • adult
  • antiretroviral therapy
  • Article
  • CD4 CD8 ratio
  • CD8 lymphocyte count
  • central nervous system
  • cohort analysis
  • female
  • follow up
  • high risk patient
  • human
  • Human immunodeficiency virus 1
  • major clinical study
  • male
  • multicenter study
  • observational study
  • practice guideline
  • priority journal
  • retrospective study
  • sustained virologic response
  • trend study

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