Nevirapine use, prolonged antiretroviral therapy and high CD4 nadir values are strongly correlated with undetectable HIV-DNA and -RNA levels and CD4 cell gain.
OBJECTIVE
To evaluate the correlations of the combination of undetectable HIV-DNA (<10 copies/10(6) peripheral blood mononuclear cells) and HIV-RNA (<1 copy/mL of plasma) levels and a CD4 cell count of >500 cells/mm(3) (defined as the treatment goal) in a group of 420 antiretroviral treatment (ART) responder patients.


METHODS
A cross-sectional, open-label, multicentre trial was conducted in a cohort of 420 HIV-infected ART-treated subjects with viral loads persistently <50 copies/mL for a median observation time of 28.8 months. HIV-DNA and residual viraemia values and demographic, virological and immunological data were collected for each subject.


RESULTS
Undetectable HIV-DNA was found in 16.6% (70/420) of patients and was significantly correlated with undetectable (<1 copy/mL) plasma viraemia (P = 0.0001). Higher CD4 cell count nadir (P < 0.001), a lower HIV-RNA viraemia at the start of treatment (P = 0.0016) and nevirapine use (P < 0.001) were correlated with an undetectable value of HIV-RNA. Twenty-six out of 420 patients (6.2%) reached the treatment goal. In multivariate analysis, higher nadir CD4 cell count (OR 3.86, 95% CI 1.47-10.16, P = 0.006), the duration of therapy (OR 1.07, 95% CI 1.02-1.12, P = 0.004) and the use of nevirapine (OR 2.59, 95% CI 1.07-6.28, P = 0.034) were independently related to this condition.


CONCLUSIONS
Only 6.2% of ART-responder patients presented the combination of three laboratory markers that identified them as full responders. These results indicate the high variability of the ART-responding population and lead us to suggest caution in the selection of patients for possible simplification regimens.
Clinical Infectious Diseases, Tor Vergata University, Rome, Italy. sarmati@med.uniroma2.it
Loredana
L
Sarmati
Saverio Giuseppe
SG
Parisi
Marco
M
Montano
Samantha
S
Andreis
Renzo
R
Scaggiante
Andrea
A
Galgani
Magdalena
M
Viscione
Gaetano
G
Maffongelli
Alessandra
A
Ricciardi
Carolina
C
Andreoni
Stefano
S
Boros
Giorgio
G
Palù
Massimo
M
Andreoni
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D019829:Nevirapine / Q000008:administration & dosage*; D012367:RNA, Viral / Q000097:blood; D016896:Treatment Outcome; D014481:United States; D019562:Viral Load
D019380:Anti-HIV Agents; D004279:DNA, Viral; D012367:RNA, Viral; D019829:Nevirapine