title: The effect of HAART on HIV RNA trajectory among treatment-naïve men and women: a segmental Bernoulli/lognormal random effects model with left censoring.
abstract: BACKGROUND
  Highly active antiretroviral therapy (HAART) rapidly suppresses human immunodeficiency virus (HIV) viral replication and reduces circulating viral load, but the long-term effects of HAART on viral load remain unclear.
  
  
  METHODS
  We evaluated HIV viral load trajectories over 8 years following HAART initiation in the Multicenter AIDS Cohort Study and the Women's Interagency HIV Study. The study included 157 HIV-infected men and 199 HIV-infected women who were antiretroviral naive and contributed 1311 and 1837 semiannual person-visits post-HAART, respectively. To account for within-subject correlation and the high proportion of left-censored viral loads, we used a segmental Bernoulli/lognormal random effects model.
  
  
  RESULTS
  Approximately 3 months (0.30 years for men and 0.22 years for women) after HAART initiation, HIV viral loads were optimally suppressed (ie, with very low HIV RNA) for 44% (95% confidence interval = 39%-49%) of men and 43% (38%-47%) of women, whereas the other 56% of men and 57% of women had on average 2.1 (1.5-2.6) and 3.0 (2.7-3.2) log10 copies/mL, respectively.
  
  
  CONCLUSIONS
  After 8 years on HAART, 75% of men and 80% of women had optimal suppression, whereas the rest of the men and women had suboptimal suppression with a median HIV RNA of 3.1 and 3.7 log10 copies/mL, respectively.
authors.affiliation: Department of Biostatistics and the Lineberger Comprehensive Cancer Center, the University of North Carolina, Chapel Hill, NC 27599, USA. hchu@bios.unc.edu
authors.forename: Haitao
authors.initials: H
authors.lastname: Chu
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Gange
authors.forename: Xiuhong
authors.initials: X
authors.lastname: Li
authors.forename: Donald R
authors.initials: DR
authors.lastname: Hoover
authors.forename: Chenglong
authors.initials: C
authors.lastname: Liu
authors.forename: Joan S
authors.initials: JS
authors.lastname: Chmiel
authors.forename: Lisa P
authors.initials: LP
authors.lastname: Jacobson
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011446:Prospective Studies; D012367:RNA, Viral / Q000187:drug effects; D013995:Time; D019562:Viral Load / Q000187:drug effects*
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral
references.citation: Math Biosci. 2004 Mar-Apr;188:47-62
references.pmid: 14766093
references.citation: N Engl J Med. 1997 Sep 11;337(11):725-33
references.pmid: 9287227
references.citation: MMWR Recomm Rep. 1992 Dec 18;41(RR-17):1-19
references.pmid: 1361652
references.citation: Lancet. 2000 Apr 1;355(9210):1158-9
references.pmid: 10791383
references.citation: J Virol. 2004 Oct;78(19):10566-73
references.pmid: 15367623
references.citation: N Engl J Med. 1999 May 27;340(21):1605-13
references.pmid: 10341272
references.citation: Biometrics. 2001 Dec;57(4):1238-44
references.pmid: 11764265
references.citation: Stat Methods Med Res. 2002 Aug;11(4):317-25
references.pmid: 12197299
references.citation: J Virol. 2003 Nov;77(22):12165-72
references.pmid: 14581553
references.citation: Ann Intern Med. 2003 Apr 15;138(8):620-6
references.pmid: 12693883
references.citation: Proc Natl Acad Sci U S A. 1998 Sep 1;95(18):10848-53
references.pmid: 9724793
references.citation: Am J Epidemiol. 2005 Oct 15;162(8):787-97
references.pmid: 16135508
references.citation: Biom J. 2005 Dec;47(6):880-7
references.pmid: 16450859
references.citation: N Engl J Med. 1999 May 27;340(21):1614-22
references.pmid: 10341273
references.citation: Biometrics. 1995 Dec;51(4):1570-8
references.pmid: 8589241
references.citation: Epidemiology. 1998 Mar;9(2):117-25
references.pmid: 9504278
references.citation: Stat Methods Med Res. 2002 Aug;11(4):303-16
references.pmid: 12197298
references.citation: Stat Med. 2005 Jan 15;24(1):65-82
references.pmid: 15523706
references.citation: JAMA. 1999 Nov 3;282(17):1627-32
references.pmid: 10553788
references.citation: J Acquir Immune Defic Syndr. 2001 Jun 1;27(2):168-75
references.pmid: 11404539
references.citation: J Epidemiol Community Health. 2006 Sep;60(9):811-8
references.pmid: 16905728
references.citation: Ann Intern Med. 2004 Feb 17;140(4):256-64
references.pmid: 14970148
references.citation: AIDS. 1999 Oct 1;13(14):1873-80
references.pmid: 10513645
references.citation: JAMA. 1998 Nov 4;280(17):1497-503
references.pmid: 9809730
references.citation: Biometrics. 1999 Jun;55(2):625-9
references.pmid: 11318225
references.citation: Am J Epidemiol. 2007 Jul 15;166(2):219-27
references.pmid: 17478436
references.citation: Am J Epidemiol. 1987 Aug;126(2):310-8
references.pmid: 3300281
references.citation: JAMA. 2005 Feb 16;293(7):817-29
references.pmid: 15713771
references.citation: AIDS. 2001 Apr 13;15(6):735-46
references.pmid: 11371688
references.citation: Science. 1997 Nov 21;278(5342):1447-50
references.pmid: 9367954