title: Rate and determinants of residual viremia in multidrug-experienced patients successfully treated with raltegravir-based regimens.
abstract: Residual HIV viremia, defined by low levels of plasma HIV RNA with enhanced-sensitivity assays, may persist even in the presence of successful antiretroviral therapy, but little is known about its determinants. Our objective was to evaluate the rate and determinants of residual viremia in patients who show stable undetectable plasma HIV-1 RNA with conventional assays. Forty-four multidrug-experienced patients with undetectable levels of HIV RNA for at least 2 years under raltegravir-based regimens were evaluated. An ultrasensitive (2.5 copies/ml) real-time PCR method was used to quantify plasma HIV RNA. After 12 months of salvage treatment, 48.3% of the patients had residual viremia between 2.5 and 37 copies/ml. The proportion of patients with plasma HIV RNA below 2.5 copies/ml decreased from 51.7% at 12 months to 30.8% at 24 months. The presence of residual viremia was not associated with levels of viremia before starting raltegravir. Considering CD4 counts, hepatitis B or C virus (HBV or HCV) coinfection, or other demographic characteristics, for the time interval between HIV diagnosis and initiation of antiretroviral therapy, patients with a longer interval (>1 year) were significant less likely to have RNA levels below 2.5 copies/ml at 12 months compared to patients who started therapy within 1 year of HIV diagnosis (28.6% vs. 73.3%, p=0.027). Half of the patients showing undetectable HIV viremia with conventional assays had low-level viremia with ultrasensitive assays, with no predictive role of viroimmunological status at the start of the regimen. The potential influence of the interval between HIV diagnosis and initiation of treatment should be confirmed in subjects with a known date of seroconversion.
authors.affiliation: 1 Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità , Rome, Italy .
authors.forename: Silvia
authors.initials: S
authors.lastname: Baroncelli
authors.forename: Maria Franca
authors.initials: MF
authors.lastname: Pirillo
authors.forename: Clementina Maria
authors.initials: CM
authors.lastname: Galluzzo
authors.forename: Anna Degli
authors.initials: AD
authors.lastname: Antoni
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Ladisa
authors.forename: Daniela
authors.initials: D
authors.lastname: Francisci
authors.forename: Gabriella
authors.initials: G
authors.lastname: d'Ettorre
authors.forename: Daniela
authors.initials: D
authors.lastname: Segala
authors.forename: Angela
authors.initials: A
authors.lastname: Vivarelli
authors.forename: Federica
authors.initials: F
authors.lastname: Sozio
authors.forename: Oscar
authors.initials: O
authors.lastname: Cirioni
authors.forename: Liliana Elena
authors.initials: LE
authors.lastname: Weimer
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Fragola
authors.forename: Giustino
authors.initials: G
authors.lastname: Parruti
authors.forename: Marco
authors.initials: M
authors.lastname: Floridia
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011760:Pyrrolidinones / Q000627:therapeutic use*; D012367:RNA, Viral / Q000097:blood; D000068898:Raltegravir Potassium; D019562:Viral Load; D014766:Viremia / Q000188:drug therapy* / Q000821:virology
chemical_list: D019380:Anti-HIV Agents; D004279:DNA, Viral; D011760:Pyrrolidinones; D012367:RNA, Viral; D000068898:Raltegravir Potassium
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