title: Ultrasensitive assessment of residual HIV viraemia in HAART-treated patients with persistently undetectable plasma HIV-RNA: a cross-sectional evaluation.
abstract: Improvements in HIV-RNA assays have made accurate detection of as few as 2 copies/ml possible. This study objective was the evaluation of ultrasensitive HIV-RNA quantitation (beneath current threshold: 50 copies/ml) in patients receiving different antiretroviral regimens. A cross-sectional, ultrasensitive measurement of HIV-RNA levels (detection limit: 2.5 HIV-RNA copies/ml) was performed in 154 HIV-1-infected patients receiving ARV therapy, all classed as full responders according to the 50 copies/ml cut-off. Patients were undergoing treatment with two nucleoside/nucleotide reverse transcriptase inhibitors (N/NtRTIs) plus nevirapine (NVP, n = 48), efavirenz (EFV, n = 57) or lopinavir/ritonavir (LPV/r, n = 49). Undetectable HIV-RNA (<2.5 copies/ml) occurred in 29/48 (60.4%), 24/57 (42.1%) and 14/49 (28.6%) NVP, EFV and LPV/r recipients, respectively. Mean virological-suppression (<50 copies/ml) duration was 28.6 months (median = 22, SD = 17.8), and only in LPV/r recipients length of suppression was associated with significantly lower HIV-RNA levels (P = 0.015). Mean nadir CD4+ cell count of 270 cells/mm(3) (median = 240, SD = 194.5) was significantly lower in the LPV/r arm (P < 0.001). Nadir CD4+ level correlated with virological suppression but had opposite trends between NVP (positive) and LPV/r (negative; two tailed P = 0.01). Logistic regression analysis showed NVP was the only independent factor associated with virologic suppression. NVP has demonstrated a distinct virological advantage at sub-clinical viral loads, possibly due to its greater penetration in extra-vascular compartments, warranting further investigation in the context of persistent low-level viraemia in long-term HAART.
authors.affiliation: Department of Infectious Diseases of the University of Torino, Torino, Italy. stefano.bonora@unito.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonora
authors.forename: Emanuele
authors.initials: E
authors.lastname: Nicastri
authors.forename: Andrea
authors.initials: A
authors.lastname: Calcagno
authors.forename: Daniel
authors.initials: D
authors.lastname: Gonzalez de Requena
authors.forename: Gabriella
authors.initials: G
authors.lastname: D'Ettorre
authors.forename: Loredana
authors.initials: L
authors.lastname: Sarmati
authors.forename: Lucia
authors.initials: L
authors.lastname: Palmisano
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Vullo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Perri
authors.forename: Massimo
authors.initials: M
authors.lastname: Andreoni
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D006678:HIV / Q000187:drug effects / Q000302:isolation & purification*; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D010949:Plasma / Q000821:virology*; D012367:RNA, Viral / Q000097:blood*; D016896:Treatment Outcome; D019562:Viral Load / Q000379:methods*; D014766:Viremia
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral