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. 2016 Jun 21:16:305.
doi: 10.1186/s12879-016-1628-6.

Viral blips during suppressive antiretroviral treatment are associated with high baseline HIV-1 RNA levels

Erik Sörstedt  1 , Staffan Nilsson  2 , Anders Blaxhult  3 , Magnus Gisslén  4 , Leo Flamholc  5 , Anders Sönnerborg  6   7 , Aylin Yilmaz  4
Affiliations

Viral blips during suppressive antiretroviral treatment are associated with high baseline HIV-1 RNA levels

Erik Sörstedt et al. BMC Infect Dis. .

Abstract

Background: Many HIV-1-infected patients on suppressive antiretroviral therapy (ART) have transiently elevated HIV RNA levels. The clinical significance of these viral blips is uncertain. We have determined the incidence of blips and investigated important associations in the Swedish HIV-cohort.

Methods: HIV-1-infected ART naïve adults who commenced ART 2007-2013 were retrospectively included. Viral blips were defined as a transient viral load between 50 and 500 copies/mL Subjects not suppressed after six months on ART were excluded.

Results: Viral blips were found in 76/735 included subjects (10.3 %) and in 90/4449 samples (2.0 %). Median blip viral load was 76 copies/mL (range 56-138). Median follow-up time was 170 weeks (range 97-240). Baseline viral load was higher in subjects with viral blips (median log10 4.85 copies/mL) compared with subjects without blips (median log10 4.55 copies/mL) (p < 0.01). There was a significant association between viral blips and risk for subsequent virological failure (p < 0.001).

Conclusions: The Swedish national HIV-cohort has a low incidence of viral blips (10 %). Blips were associated with high baseline viral load and an increased risk of subsequent virological failure.

Keywords: Antiretroviral therapy; HIV-1; Transient viremia; Viral blip.

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Figures

Fig. 1
Fig. 1
Figure 1 shows all 735 included patients and 4449 samples analysed. The y-axis represents all included patients on stacked horizontal lines (not included) depending on when they entered the study and the x-axis represents the study period. Each dot represents a blood sample. Grey empty circles show HIV RNA < 50 copies/mL, red filled circles indicate a blip between 50 and 500 copies/mL and black filled circles indicate viral failure
Fig. 2
Fig. 2
Figure 2 shows patients with blips. The y-axis represents the 76 patients with registered viral blips on stacked horizontal lines (not included) depending on when they entered the study and the x-axis represents the study period. Each circle represents a blood sample. Grey empty circles indicate HIV RNA < 20 copies/mL, yellow filled circles low-level viremia (20–50 copies/mL), red filled circles a blip between 50 and 500 copies/mL, and black filled circles signal viral failure
Fig. 3
Fig. 3
Pre-treatment viral load in subjects with and without viral blips. Line indicates median log10 HIV RNA
Fig. 4
Fig. 4
Columns represent the percentage of HIV RNA samples 50–500 copies/mL in comparison to the total number of HIV RNA analysed per year since data collection started (a) and in comparison to calendar year (b). The first sample in each subject is removed since it is below 50 copies/mL by inclusion criteria
See this image and copyright information in PMC

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