Impact of low-level viremia with drug resistance on CD4 cell counts among people living with HIV on antiretroviral treatment in ... View Full Text


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Article Info

DATE

2022-05-04

AUTHORS

Pengtao Liu, Yinghui You, Lingjie Liao, Yi Feng, Yiming Shao, Hui Xing, Guanghua Lan, Jianjun Li, Yuhua Ruan, Dan Li

ABSTRACT

BackgroundMaintaining plasma HIV RNA suppression below the limit of quantification is the goal of antiretroviral therapy (ART). When viral loads (VL) remain in low-level viremia (LLV), or between 201 and 999 copies/mL, the clinical consequences are still not clear. We investigated the occurrence of LLV with drug resistance and its effect on CD4 cell counts in a large Chinese cohort.MethodsWe analysed data of 6,530 ART-experienced patients (42.1 ± 10.9 years; 37.3% female) from the China’s national HIV drug resistance (HIVDR) surveillance database. Participants were followed up for 32.9 (IQR 16.7–50.5) months. LLV was defined as the occurrence of at least one viral load (VL) measurement of 50–200 copies/mL during ART. Outcomes were drug resistance associated mutations (DRAM) and CD4 cell counts levels.ResultsAmong 6530 patients, 58.0% patients achieved VL less than 50 copies/mL, 27.8% with VL between 50 and 999 copies/mL (8.6% experienced LLV), and 14.2% had a VL ≥ 1000 copies/mL. Of 1818 patients with VL 50–999 copies/mL, 182 (10.0%) experienced HIVDR, the most common DRAM were M184I/V 28.6%, K103N 19.2%, and V181C/I/V 10.4% (multidrug resistance: 27.5%), and patients with HIVDR had a higher risk of CD4 cell counts < 200 cells/μL (AOR 3.8, 95% CI 2.6–5.5, p < 0.01) comparing with those without HIVDR. Of 925 patients with VL ≥ 1000 copies/mL, 495 (53.5%) acquired HIVDR, the most common DRAM were K103N 43.8%, M184I/V 43.2%, M41L 19.0%, D67N/G 16.4%, V181C/I/V 14.5%, G190A/S 13.9% and K101E 13.7% (multidrug resistance: 75.8%), and patients with HIVDR had a higher risk of CD4 cell counts < 200 cells/μL (AOR 5.8, 95% CI 4.6–7.4, p < 0.01) comparing with those without HIVDR.ConclusionPersistent with VL 50–999 copies/mL on ART is associated with emerging DRAM for all drug classes, and patients in this setting were at increased risk of CD4 cell counts < 200 cells/μL, which suggest resistance monitoring and ART optimization be earlier considered. More... »

PAGES

426

References to SciGraph publications

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    http://scigraph.springernature.com/pub.10.1186/s12879-022-07417-z

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    http://dx.doi.org/10.1186/s12879-022-07417-z

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    https://app.dimensions.ai/details/publication/pub.1147615249

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/35509014


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        "description": "BackgroundMaintaining plasma HIV RNA suppression below the limit of quantification is the goal of antiretroviral therapy (ART). When viral loads (VL) remain in low-level viremia (LLV), or between 201 and 999 copies/mL, the clinical consequences are still not clear. We investigated the occurrence of LLV with drug resistance and its effect on CD4 cell counts in a large Chinese cohort.MethodsWe analysed data of 6,530 ART-experienced patients (42.1\u2009\u00b1\u200910.9\u00a0years; 37.3% female) from the China\u2019s national HIV drug resistance (HIVDR) surveillance database. Participants were followed up for 32.9 (IQR 16.7\u201350.5) months. LLV was defined as the occurrence of at least one viral load (VL) measurement of 50\u2013200 copies/mL during ART. Outcomes were drug resistance associated mutations (DRAM) and CD4 cell counts levels.ResultsAmong 6530 patients, 58.0% patients achieved VL less than 50 copies/mL, 27.8% with VL between 50 and 999 copies/mL (8.6% experienced LLV), and 14.2% had a VL\u2009\u2265\u20091000 copies/mL. Of 1818 patients with VL 50\u2013999 copies/mL, 182 (10.0%) experienced HIVDR, the most common DRAM were M184I/V 28.6%, K103N 19.2%, and V181C/I/V 10.4% (multidrug resistance: 27.5%), and patients with HIVDR had a higher risk of CD4 cell counts\u2009<\u2009200 cells/\u03bcL (AOR 3.8, 95% CI 2.6\u20135.5, p\u2009<\u20090.01) comparing with those without HIVDR. Of 925 patients with VL\u2009\u2265\u20091000 copies/mL, 495 (53.5%) acquired HIVDR, the most common DRAM were K103N 43.8%, M184I/V 43.2%, M41L 19.0%, D67N/G 16.4%, V181C/I/V 14.5%, G190A/S 13.9% and K101E 13.7% (multidrug resistance: 75.8%), and patients with HIVDR had a higher risk of CD4 cell counts\u2009<\u2009200 cells/\u03bcL (AOR 5.8, 95% CI 4.6\u20137.4, p\u2009<\u20090.01) comparing with those without HIVDR.ConclusionPersistent with VL 50\u2013999 copies/mL on ART is associated with emerging DRAM for all drug classes, and patients in this setting were at increased risk of CD4 cell counts\u2009<\u2009200 cells/\u03bcL, which suggest resistance monitoring and ART optimization be earlier considered.", 
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