title: Is moderate HIV viremia associated with a higher risk of clinical progression in HIV-infected people treated with highly active antiretroviral therapy: evidence from the Italian cohort of antiretroviral-naive patients study.
abstract: OBJECTIVE
  To assess the risk of clinical progression (CP) according to the duration of time spent without complete viral load (VL) suppression compared with that associated with periods of stably suppressed viremia in HIV-infected people who started highly active antiretroviral therapy (HAART) when previously naïve to antiretrovirals.
  
  
  METHODS
  A cohort study of patients having started HAART after enrollment in the Italian Cohort of Antiretroviral-Naive Patients (ICoNA) and being followed for at least 6 months.
  
  
  METHODS
  Person-years spent in different categories according to the VL level and the change in VL from the most recent value before the initiation of HAART were calculated. A multivariable Poisson regression model, including potential confounders, was constructed.
  
  
  RESULTS
  A total of 3023 patients were studied. The overall rate of CP was 13.4 per 1000 person-years. Evidence for a higher risk of CP was observed for people with a current VL >10,000 copies/mL. For each year longer spent on HAART with a VL >100,000 copies/mL, a 5-fold increased risk was observed (relative risk [RR] = 5.34, 95% confidence interval [CI]: 2.83 to 1.08; P = 0.0001). An increased risk of CP in patients with current suppression <1.5 log10 copies/mL (RR = 2.34, 95% CI: 1.16 to 4.74; P = 0.02) and in those with no suppression or a VL higher than their set point (RR = 2.39, 95% CI: 1.17 to 4.89; P = 0.02) was observed compared with those with suppression of >3 log10 copies/mL, although it was not significant. Longer duration on HAART with a VL suppressed below set point seemed to confer protection against CP.
  
  
  CONCLUSIONS
  Virologic failure to antiretroviral drugs is common. The risk of CP may remain low despite a low but detectable level of HIV viremia.
authors.affiliation: Istituto di Clinica delle Malattie Infettive, Università Cattolica S. Cuore of Rome, Rome, Italy. ritamurri@libero.it
authors.forename: Rita
authors.initials: R
authors.lastname: Murri
authors.forename: Alessandro Cozzi
authors.initials: AC
authors.lastname: Lepri
authors.forename: Paola
authors.initials: P
authors.lastname: Cicconi
authors.forename: Antonio
authors.initials: A
authors.lastname: Poggio
authors.forename: Massimo
authors.initials: M
authors.lastname: Arlotti
authors.forename: Giulia
authors.initials: G
authors.lastname: Tositti
authors.forename: Domenico
authors.initials: D
authors.lastname: Santoro
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Soranzo
authors.forename: Giuliano
authors.initials: G
authors.lastname: Rizzardini
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Colangeli
authors.forename: Maria
authors.initials: M
authors.lastname: Montroni
authors.forename: Antonella D'Arminio
authors.initials: AD
authors.lastname: Monforte
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology*; D006801:Humans; D007558:Italy; D008297:Male; D016012:Poisson Distribution; D012044:Regression Analysis; D012307:Risk Factors