(P8) Half of patients with baseline HIV-RNA >500,000 copies/mL do not reach the treatment goal of <50 within 6 months

Författare/Medförfattare

Erik Sörstedt [1], Leo Flamholc[2], Bo Hejdeman[3], Piotr Nowak[4], Magnus Gisslén[1], Aylin Yilmaz[1]

Affiliates

[1] University of Gothenburg, Sweden [2] Malmö University Hospital, Sweden [3] Södersjukhuset, Sweden [4] Karolinska Institute, Sweden

Abstract

Background
Previous studies evaluating the importance of high baseline viral load have mainly focused on HIV RNA at >100,000 copies/mL, and there is a lack of studies on treatment outcome in patients starting antiretroviral treatment (ART) with very high baseline HIV RNA levels, i.e. >500,000 copies/mL.

Methods
Retrospective study using the nationwide InfCare HIV database to compare treatment outcome in subgroups of people living with HIV in Sweden depending on baseline HIV RNA levels.
All treatment naïve patients, ≥18 years old and diagnosed with HIV-1 who started ART from year 2000 were included. Patients with primary HIV infections were excluded. Very high baseline viral load was defined as HIV RNA ≥ 500,000 copies/mL. Virological failure was defined as two consecutive blood samples with > 150 HIV RNA copies/mL or one sample > 1,000 copies/mL, ≥12 months after treatment initiation. Treatment response was measured in days between treatment initiation and the first sample with <50 HIV RNA copies/mL.

Results
In comparison to patients with baseline HIV RNA <500,000 copies/mL (N=3,624), it took significantly longer for patients with very high viral load (N=623) to reach HIV-RNA <50 copies/mL (median of 188 vs 116 days, respectively, p<0.0001). Fifty-five percent of patients with baseline HIV RNA >500,000 copies/mL did not reach the treatment goal of <50 copies/ml within 6 months of therapy compared to 36% of patients with baseline viral load 100,000-500,000 (N=1232), and 15 % of patients with baseline HIV RNA <100,000 copies/mL (N=2392). Twenty one percent, compared to 14% and 7%, respectively, had still HIV-RNA >50 copies/mL after 12 months of ART. The percentages of patients with Non-nucleoside reverse transcriptase inhibitors, protease inhibitors and integrase inhibitors as core agents did not differ between the groups. Virological failures was uncommon (in total 6%) and with no association to baseline viral load. Median follow up time was 173 weeks (IQR 8-373 weeks).

Conclusion
Longer than 6 months ART is often required to reach <50 HIV RNA copies/mL in patients with very high baseline viral load. However, this does not influence the risk of treatment failure after 12 months of treatment.

Keywords
HIV RNA, antiretroviral therapy, Baseline viral load

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