title: Predictors of virological rebound in HIV-1-infected patients initiating a protease inhibitor-containing regimen.
abstract: OBJECTIVE
  To study the predictors of virological rebound in patients having early virological response to protease inhibitor (PI)-containing regimen.
  
  
  METHODS
  APROCO cohort study prospectively enrolled 1283 HIV-infected patients starting a PI-containing regimen in 1997-1999. Adherence to therapy was measured with self-administered questionnaires after 4 months of therapy (M4). Virological rebound was defined as a viral load (VL) > 500 copies/ml in patients having early virological response, defined as a VL < 500 copies/ml at M4. Predictors of time to virological rebound were studied with multivariate proportional hazards model.
  
  
  RESULTS
  During a median follow-up of 20 months, virological rebound was observed in 32% of the 830 patients with early virological response. Virological rebound was more frequent when patients had received previous antiretroviral treatment [adjusted hazards ratio (HR) = 2.4; P < 0.0001], were younger (HR = 1.4 per each 10 years younger; P < 0.0001), had baseline CD4 cell count < 500 x 106/l (HR = 2.3; P < 0.001), had higher baseline VL (HR = 1.4 per each log10 copies/ml higher; P < 0.001), reported low adherence to therapy at M4 (HR = 2.1; P < 0.001) or had stopped PI at M4 (HR = 1.7; P = 0.04).
  
  
  CONCLUSIONS
  Initiation of treatment at a stage of preserved immunity is associated with a more durable virological response under protease inhibitor. Every effort should be made to monitor and strengthen adherence to therapy, even in patients having early virological response.
authors.affiliation: Service des Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Paris, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Le Moing
authors.forename: Geneviève
authors.initials: G
authors.lastname: Chêne
authors.forename: Maria P
authors.initials: MP
authors.lastname: Carrieri
authors.forename: Ahmadou
authors.initials: A
authors.lastname: Alioum
authors.forename: Françoise
authors.initials: F
authors.lastname: Brun-Vézinet
authors.forename: Lionel
authors.initials: L
authors.lastname: Piroth
authors.forename: Jill P
authors.initials: JP
authors.lastname: Cassuto
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Moatti
authors.forename: François
authors.initials: F
authors.lastname: Raffi
authors.forename: Catherine
authors.initials: C
authors.lastname: Leport
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011237:Predictive Value of Tests; D012367:RNA, Viral / Q000097:blood; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors