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Observational Study
. 2020 Sep;21(8):523-535.
doi: 10.1111/hiv.12885. Epub 2020 Jun 24.

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

L Taramasso  1 , M Fabbiani  2 , S Nozza  3 , I De Benedetto  4 , E Bruzzesi  3 , A Mastrangelo  3 , C Pinnetti  5 , A Calcagno  4 , M Ferrara  4 , G Bozzi  1 , E Focà  6 , E Quiros-Roldan  6 , D Ripamonti  7 , M Campus  8 , B M Celesia  9 , C Torti  10 , L Cosco  11 , A Di Biagio  12 , S Rusconi  13 , G Marchetti  14 , C Mussini  15 , R Gulminetti  2 , A Cingolani  16 , G d'Ettorre  17 , G Madeddu  18 , A Franco  19 , G Orofino  20 , N Squillace  21   22 , A Muscatello  1 , A Gori  1   23 , A Antinori  5 , G Tambussi  3 , A Bandera  1   23 ; INACTION study group
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Free article
Observational Study

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

L Taramasso et al. HIV Med. 2020 Sep.
Free article

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 < 50 HIV-1 RNA copies/mL); (2) virologic failure [> 1000 copies/mL after achievement of < 200 copies/mL, or ≥ 200 copies/mL after 24 weeks on an antiretroviral therapy (ART)]; (3) suboptimal viral response (> 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.

Keywords: acute HIV infection; blip; early antiretroviral treatment; incomplete viral response; virologic failure.

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References

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