title: Virological suppression reduces clinical progression in patients with multiclass-resistant HIV type 1.
abstract: The virological and immunological outcomes in patients carrying multiclass-resistant HIV-1, their predictors, and their impact on disease progression were investigated. Antiretroviral-experienced patients carrying at least one primary resistance mutation (IAS-USA 2006) to two to three classes of antiretroviral drugs were analyzed for achieving an HIV-1 RNA <50 copies/ml, a CD4 count increase of >200 cells/microl from baseline, and progression to an AIDS-defining event or death. Survival analysis was performed using the Kaplan-Meier estimates and predictors of different outcomes were analyzed using Cox's regression models. A total of 236 patients were identified. Of these 73% reached HIV-1 RNA <50 copies/ml. Higher genotypic sensitivity score of the salvage regimen, lower viral load, and more recent calendar year at genotyping were independently associated with virological response. Immunological response (58%) was predicted by a more recent calendar year, the achievement of an undetectable viral load, and higher CD4 counts at genotyping. Thirty-three patients showed clinical progression: achieving HIV-1 RNA <50 copies/ml predicted AIDS-free survival, independently from other significant cofactors. In individuals with multiclass-resistant HIV-1, virological suppression and immunological recovery are becoming more easily accessible with more recent therapies. The achievement of virological suppression is a strong predictor of reduced clinical progression.
authors.affiliation: Institute of Clinical of Infectious Disease, Catholic University of Sacred Heart, Rome, Italy. laura.bracciale@poste.it
authors.forename: Laura
authors.initials: L
authors.lastname: Bracciale
authors.forename: Simona
authors.initials: S
authors.lastname: Di Giambenedetto
authors.forename: Manuela
authors.initials: M
authors.lastname: Colafigli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: La Torre
authors.forename: Mattia
authors.initials: M
authors.lastname: Prosperi
authors.forename: Rosaria
authors.initials: R
authors.lastname: Santangelo
authors.forename: Simona
authors.initials: S
authors.lastname: Marchetti
authors.forename: Roberto
authors.initials: R
authors.lastname: Cauda
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fadda
authors.forename: Andrea
authors.initials: A
authors.lastname: De Luca
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D024882:Drug Resistance, Viral; D015658:HIV Infections / Q000276:immunology* / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D053208:Kaplan-Meier Estimate; D016879:Salvage Therapy; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents