An undetectable polymerase chain reaction signal in
routine HIV plasma viral load monitoring is associated
with better virological outcomes in patients receiving
highly active antiretroviral therapy*
P Pugliese,
1
C Delpierre,
2
L Cuzin,
3
I Poizot-Martin,
4,5
D Rey,
6
K Saune,
7
J Cottalorda,
8
D Bettinger,
9
C Delaugerre
10,11
and B Hoen
12,13
for the Dat AIDS Study Group
†
1
Department of Infectious Diseases, Hôpital de l’Archet, Nice, France,
2
Inserm UMR1027, Université de Toulouse III,
Toulouse, France,
3
Department of Infectious Diseases, Hôpital Purpan, Toulouse, France,
4
Inserm U912 (SESSTIM),
Université d’Aix Marseille, Marseille, France,
5
Department of Clinical Immunology and Hematology, APHM
Sainte-Marguerite, Marseille, France,
6
HIV Care Centre, Hôpitaux Universitaires, Strasbourg, France,
7
Laboratory of
Virology, Hôpital Purpan, Toulouse, France,
8
Laboratory of Virology, Hôpital de l’Archet, Nice, France,
9
Laboratory
of Virology, CHRU de Besançon, Besançon, France,
10
Inserm U941, Université Paris Diderot, Paris, France,
11
Laboratory of Virology, Hôpital Saint-Louis, APHP, Paris, France,
12
Université de Franche-Comté, UMR CNRS
6249 Chrono-environnement, Besançon, France and
13
Department of Infectious Diseases, CHRU de Besançon,
Besançon, France
Objectives
The aim of the study was to assess whether patients with undetectable viraemia [a negative
polymerase chain reaction result (PCR
neg
)] and those with plasma viral load (PVL) < 40 HIV-1
RNA copies/mL but a detectable (positive) PCR signal (PCR
pos
) had different outcomes in terms
of the development of blips and virological failure (VF).
Methods
A multicentre observational database analysis was carried out. Data for patients whose highly
active antiretroviral therapy (HAART) regime had been unchanged for 6 months by 1 January
2008, whose first two PVL measurements of 2008 were < 40 copies/mL and who had at least
five PVL measurements between 1 January 2008 and 31 December 2010 were extracted from a
multicentre observational database of 4928 patients receiving HAART. PVL assays used during
this period had a detection threshold of 20 or 40 copies/mL. Undetectable PVL at baseline
(BLPCR
neg
) was defined as PCR
neg
at the first two PVL determinations of 2008. Multivariable Cox
regression analysis was performed to investigate factors associated with the occurrence of blips
and VF, defined as two consecutive PVL measurements > 40 copies/mL.
Results
Of the 1957 patients included in the study (mean age 47 years; median antiretroviral exposure
10.3 years), 1312 had BLPCR
neg
. Outcome events included 322 blips and 139 VFs, with incidence
rates being significantly lower in patients with BLPCR
neg
than in those with BLPCR
pos
[13.0% vs.
23.4% (P < 0.0001) and 5.1% vs. 11.2% (P < 0.0001), respectively]. In multivariable analysis,
BLPCR
neg
was associated with a reduced risk of blips [hazard ratio (HR) 0.58; 95% confidence
interval (CI) 0.47–0.73; P < 0.0001] and VF (HR 0.44; 95% CI 0.31–0.62; P < 0.0001).
Correspondence: Dr Bruno Hoen, Service de Maladies Infectieuses et Tropicales, CHU de Besançon, Hôpital Saint-Jacques, 25030 Besançon Cedex, France.
Tel: 33 381 218 533; fax: 33 381 218 772; e-mail: bruno.hoen@univ-fcomte.fr
*This work was presented in part at the 19th Conference on Retroviruses and Opportunistic Infections, Seattle, WA, 5–8 March 2012 (poster L-134).
†
See Appendix.
DOI: 10.1111/hiv.12041
© 2013 British HIV Association HIV Medicine (2013)
SHORT COMMUNICATION
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