title: Transient rebounds of low-level viraemia among HIV-infected patients under HAART are not associated with virological or immunological failure.
abstract: OBJECTIVE
  To analyse whether blips are associated with a higher risk of virological or immunological failure than persistent undetectable viraemia (UND) among HIV-infected patients receiving HAART.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Patients with blips or UND were selected from a prospective cohort of 330 patients under HAART for over 48 weeks. Blips were defined as detectable viraemia up to a maximum of 1000 copies/ml preceded by two consecutive visits and followed by one visit showing undetectable viraemia. Patients were included according to the following criteria: i) Blip group: patients that showed transient relapses of viraemia; ii) UND group: patients who had achieved UND on HAART before 24 weeks of therapy and that sustained viral suppression for four consecutive visits.
  
  
  METHODS
  Virological and immunological failure.
  
  
  RESULTS
  Thirty seven (11%) and 65 (20%) patients showed blips and persistent UND, respectively. Virological failure was observed in three (8.1%) patients in the blip group and 11 (16.9%) patients in the UND group (P=0.25). The time to virological failure was shorter in the UND group (P=0.12). The rates of virological failure and the time to virological failure were similar between both groups after excluding patients with compliance <95%. The time to immunological failure was also similar in both groups (P=0.5). In a Cox model, only the use of saquinavir hard gel-based regimens was independently associated with the time to virological and immunological failure.
  
  
  CONCLUSIONS
  Patients under HAART with transient low-level viraemia are not at an increased risk of developing virological or immunological failure.
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario de Valme, Seville, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Mira
authors.forename: Juan
authors.initials: J
authors.lastname: Macías
authors.forename: Carmen
authors.initials: C
authors.lastname: Nogales
authors.forename: Javier
authors.initials: J
authors.lastname: Fernández-Rivera
authors.forename: José A
authors.initials: JA
authors.lastname: García-García
authors.forename: Antonio
authors.initials: A
authors.lastname: Ramos
authors.forename: Juan A
authors.initials: JA
authors.lastname: Pineda
mesh_terms: D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019562:Viral Load; D014766:Viremia / Q000188:drug therapy*