title: Predictors of residual viremia in HIV-infected patients successfully treated with efavirenz and lamivudine plus either tenofovir or stavudine.
abstract: In human immunodeficiency virus (HIV)-infected patients successfully treated with highly active antiretroviral therapy (HAART), a low level of HIV RNA persists in plasma at steady state for years and varies among patients. To understand predictors of residual viremia, we measured HIV RNA levels <50 copies/mL in patients after 1 year of treatment with efavirenz and lamivudine plus either tenofovir disoproxil fumarate (n=55) or stavudine (n=45), by use of an HIV RNA assay with a limit of detection of 2.5 copies/mL. The mean posttreatment HIV RNA levels were 0.58 log(10) copies/mL (3.8 copies/mL) in the tenofovir arm and 0.61 log(10)copies/mL (4.1 copies/mL) in the stavudine arm (P=.24). Forty-seven percent of patients receiving tenofovir, compared with 29% of patients receiving stavudine, had undetectable residual viremia (P=.07). In multivariate analyses, we found that lower baseline HIV RNA levels in plasma, lower HIV DNA levels in peripheral blood mononuclear cells, and inclusion in the tenofovir arm each independently predicted undetectable residual viremia (P<.05). However, a level of residual viremia <50 copies/mL was not associated with CD4 cell count changes or risk of virologic rebound through 72 weeks of follow-up.
authors.affiliation: Department of Medicine, San Francisco General Hospital, University of California at San Francisco, San Francisco, California, USA. dhavlir@php.ucsf.edu
authors.forename: Diane V
authors.initials: DV
authors.lastname: Havlir
authors.forename: Kersten K
authors.initials: KK
authors.lastname: Koelsch
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Strain
authors.forename: Nicolas
authors.initials: N
authors.lastname: Margot
authors.forename: Biao
authors.initials: B
authors.lastname: Lu
authors.forename: Caroline C
authors.initials: CC
authors.lastname: Ignacio
authors.forename: Michael D
authors.initials: MD
authors.lastname: Miller
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Wong
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D048588:Benzoxazines; D018791:CD4 Lymphocyte Count; D003521:Cyclopropanes; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006678:HIV / Q000187:drug effects / Q000502:physiology*; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D019259:Lamivudine / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D063065:Organophosphonates / Q000494:pharmacology / Q000627:therapeutic use; D010078:Oxazines / Q000494:pharmacology / Q000627:therapeutic use; D012367:RNA, Viral / Q000097:blood; D018119:Stavudine / Q000494:pharmacology / Q000627:therapeutic use; D000068698:Tenofovir; D014766:Viremia
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D004279:DNA, Viral; D063065:Organophosphonates; D010078:Oxazines; D012367:RNA, Viral; D019259:Lamivudine; D000068698:Tenofovir; D018119:Stavudine; D000225:Adenine; C098320:efavirenz