Consecutive rebounds in plasma viral load are associated with virological failure at 52 weeks among HIV-infected patients.
OBJECTIVE
To describe the characteristics and predictors of transient plasma viral load (pVL) rebounds among patients on stable antiretroviral therapy and to determine the effect of one or more pVL rebounds on virological response at week 52.


METHODS
Individual data were combined from 358 patients from the INCAS, AVANTI-2 and AVANTI-3 studies. Logistic regression models were used to determine the relationship between the magnitude of an increase in pVL and the probability of returning to the lower limit of quantification (LLOQ: 20-50 copies/ml) and to determine the odds of virological success at 52 weeks associated with single and consecutive pVL rebounds.


RESULTS
A group of 165 patients achieved a pVL nadir < LLOQ; of these, 85 patients experienced pVL rebounds within 52 weeks. The probability of a pVL rebound was greater among patients who did not adhere to treatment (68% vs 49%; P < 0.05). The probability of reachieving virological suppression after a pVL rebound was not associated with the magnitude of the rebound [odds ratio (OR), 0.86; P = 0.56] but was associated with triple therapy (OR, 2.22; P = 0.06) or non-adherence (OR, 0.40; P = 0.04). The probability of virological success at week 52 was not associated with an isolated pVL rebound but was less likely after detectable pVL at two consecutive visits.


CONCLUSIONS
An isolated pVL rebound was not associated with virological success at 52 weeks but rebounds at two consecutive visits decreased the probability of later virological success. Given their high risk of short-term virological failure, patients who present with consecutive detectable pVL measurements following complete suppression should be considered ideal candidates for intervention studies.
Raboud
Janet M
JM
Department of Public Health Sciences and Division of Infectious Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Rae
Sandra
S
Woods
Ryan
R
Harris
Marianne
M
Montaner
Julio S G
JS
D023241:Antiretroviral Therapy, Highly Active; D004311:Double-Blind Method; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D006801:Humans; D012680:Sensitivity and Specificity; D019562:Viral Load