title: Time to HIV-1 RNA suppression below 5 copies/ml during first-line protease inhibitor-based antiretroviral treatment - any impact of residual viremia on treatment success?
abstract: When antiretroviral treatment suppresses HIV RNA levels to below 50 copies/ml, traces of viremia may still be detected with more sensitive assays. In the ARTEMIS trial, 689 antiretroviral treatment-naive patients were randomized to tenofovir/emtricitabine plus either darunavir/ritonavir (n = 343) or lopinavir/ritonavir (n = 346). HIV-1 RNA was evaluated using the Roche Amplicor® Ultrasensitive assay: plasma samples with HIV RNA < 50 copies/ml were classified as either "No HIV RNA detected" (< 5 HIV RNA copies/ml, optical density = background) or HIV RNA detected (5-50 copies/ml). The percentage of patients in each arm with HIV RNA < 5 copies/ml rose progressively from week 2 to week 192. For patients with baseline HIV RNA ≥ 100,000, the percentage with HIV RNA < 5 copies/ml at week 192 was 66% for darunavir/ritonavir and 63% for lopinavir/ritonavir. For patients with baseline HIV RNA < 100,000 copies/ml, the percentage with HIV RNA < 5 copies/ml at week 192 was 79% for darunavir/ritonavir versus 77% for lopinavir/ritonavir. Of the patients on darunavir/ritonavir with HIV RNA < 50 copies/ml, 63% had levels < 5 copies/ml at week 48, versus 80% at week 192. In summary, HIV-1 RNA suppression to < 5 copies/ml is dependent on baseline HIV RNA levels. The HIV RNA levels can remain under quantification limits but still detectable after 2-4 years of antiretroviral treatment.
authors: Ospedale Papa Giovanni XXIII, Italy.
authors: Diego
authors: D
authors: Ripamonti
authors: Andrew
authors: A
authors: Hill
authors: Erkki
authors: E
authors: Lauthouwers
authors: Yvon
authors: Y
authors: van Delft
authors: Christiane
authors: C
authors: Moecklinghoff
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D000069454:Darunavir; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics*; D006801:Humans; D061466:Lopinavir / Q000494:pharmacology / Q000627:therapeutic use; D012367:RNA, Viral / Q000097:blood*; D019438:Ritonavir / Q000494:pharmacology / Q000627:therapeutic use; D013449:Sulfonamides / Q000494:pharmacology / Q000627:therapeutic use; D019562:Viral Load; D014766:Viremia / Q000188:drug therapy / Q000821:virology
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D013449:Sulfonamides; D061466:Lopinavir; D019438:Ritonavir; D000069454:Darunavir