title: Residual viraemia does not influence 1 year virological rebound in HIV-infected patients with HIV RNA persistently below 50 copies/mL.
abstract: OBJECTIVE
  It is currently debated whether patients with residual viraemia are at higher risk of virological failure than those attaining <1 HIV RNA copy/mL. We therefore investigated the effect of residual viraemia on virological rebound.
  
  
  METHODS
  We used a prospective, non-interventional, single-centre, study. This analysis was based on HIV-infected patients with two consecutive HIV RNA viral loads (VLs) of <50 copies/mL as tested by Versant bDNA, followed by two HIV RNA VLs of <50 copies/mL as tested using the Versant kinetic PCR molecular system (kPCR; limit of quantification = 1 copy/mL). Virological rebound was defined as two consecutive HIV RNA values of >50 copies/mL after baseline, and the time to virological rebound was calculated using the Kaplan-Meier method.
  
  
  RESULTS
  There were 739 eligible patients; 446 (60.4%) had HIV RNA <1 copy/mL (group A) and 293 (39.6%) had residual viraemia (1-49 HIV RNA copies/mL; group B). After a follow-up (median 48.9 weeks), virological rebound occurred in four patients in group A (0.9%) and six patients in group B (2%); the time to virological rebound was similar in the two groups (log-rank test P = 0.231). CD4+ cell recovery (slope) was significantly less in the patients with residual viraemia; +14.3 (-7.7, 43.9) cells/mm(3) per year versus +21.2 (-2.5, 53.2) cells/mm(3) per year; P = 0.036.
  
  
  CONCLUSIONS
  Residual viraemia assessed by kPCR was not associated with virological rebound during 1 year of follow-up. However, the patients attaining <1 HIV RNA copy/mL showed a small but statistically significant improvement in CD4+ cell recovery.
authors: Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy. nicola.gianotti@hsr.it
authors: Nicola
authors: N
authors: Gianotti
authors: Laura
authors: L
authors: Galli
authors: Sara
authors: S
authors: Racca
authors: Stefania
authors: S
authors: Salpietro
authors: Francesca
authors: F
authors: Cossarini
authors: Vincenzo
authors: V
authors: Spagnuolo
authors: Beatrice
authors: B
authors: Barda
authors: Filippo
authors: F
authors: Canducci
authors: Massimo
authors: M
authors: Clementi
authors: Adriano
authors: A
authors: Lazzarin
authors: Antonella
authors: A
authors: Castagna
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood*; D012008:Recurrence; D012307:Risk Factors; D017211:Treatment Failure; D019562:Viral Load; D014766:Viremia
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral