title: Viremia copy-years as a predictive marker of all-cause mortality in HIV-1-infected patients initiating a protease inhibitor-containing antiretroviral treatment.
abstract: BACKGROUND
  Viremia copy-years (VCY) has been reported as a short-term predictor of mortality. We evaluated the association of this parameter with 10-year outcome within the APROCO-COPILOTE cohort.
  
  
  METHODS
  Prospective data from 1281 HIV-1-infected patients who started a first protease inhibitor-containing regimen in 1997-1999 were analyzed. Patients with baseline plasma viral load (pVL) > 500 copies per milliliter and at least 2 pVL measures from the eighth month of follow-up were selected. VCY was calculated individually over the follow-up as the area under the pVL curve. Multivariate Cox models analyzed the relation between all-cause mortality and the following variables: age, sex, geographical origin, transmission group, HIV infection duration, ART-naive, pVL at baseline, time-dependent CD4 count, and VCY.
  
  
  RESULTS
  Nine hundred seventy-nine patients were followed up for a median of 10 years (interquartile range: 5-11.5). At baseline, median (interquartile range) values for duration of HIV infection, pVL, and CD4 cell count were 43 (4-95) months, 4.6 (3.9-5.2) log10 copies per milliliter, and 278 (125-416) cells per cubic millimeter, respectively. At censoring date, 77 patients (8%) had died. VCY >1.4 log10 copies × yrs/mL was an independent predictor of death (hazard ratio: 2.0; 95% confidence interval: 1.2 to 3.5), which was no longer the case after adjustment for the latest pVL value [risk ratio (RR): 1.2 for 1 additional log10 copies per milliliter; 95% confidence interval: 1.1 to 1.4].
  
  
  CONCLUSIONS
  VCY was associated with mortality in HIV-infected patients under combined antiretroviral therapy but did not overweigh the predictive value of the latest pVL. VCY might be more useful as a marker of persistent viral replication than for routine clinical care.
authors.affiliation: *UMR 6249 Chrono-environnement, Université de Franche-Comté Besançon, France; Service de Maladies Infectieuses et Tropicales, CHRU Besançon, Besançon, France; †Université de Bordeaux, Bordeaux, France; INSERM U897, Bordeaux, France; ‡Service de maladies infectieuses, CHU de Montpellier, UMI 233 Institut de Recherche sur le Développement/Université Montpellier 1, Montpellier, France; §CMIT, Paris, France; ‖Department of Infectious Diseases, CHU Dijon, Dijon, France; UMR 1347, University of Burgundy, Dijon, France; ¶CHU de Bordeaux, Laboratoire de Virologie, Bordeaux, France; University of Bordeaux, CNRS UMR 5234, Bordeaux, France; #Hematology department Hôpital de L'Archet, Nice, France; **INSERM U897, University of Bordeaux, CHU Bordeaux, Bordeaux, France; ††INSERM UMR 1137 IAME, Université Paris Diderot, Sorbonne Paris, France; Unité de Coordination du Risque Épidémique et Biologique, Assistance Publique-Hôpitaux de Paris, Paris, France; and ‡‡EA 4537 "Maladies Infectieuses et Tropicales dans la Caraïbe," Université des Antilles et de la Guyane, Pointe-à-Pitre, France; Service de Maladies Infectieuses et Tropicales, CHU de Pointe-à-Pitre, Pointe-à-Pitre, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chirouze
authors.forename: Valérie
authors.initials: V
authors.lastname: Journot
authors.forename: Vincent
authors.initials: V
authors.lastname: Le Moing
authors.forename: François
authors.initials: F
authors.lastname: Raffi
authors.forename: Lionel
authors.initials: L
authors.lastname: Piroth
authors.forename: Sandrine
authors.initials: S
authors.lastname: Reigadas
authors.forename: Jill-Patrice
authors.initials: JP
authors.lastname: Cassuto
authors.forename: Geneviève
authors.initials: G
authors.lastname: Chêne
authors.forename: Catherine
authors.initials: C
authors.lastname: Leport
authors.forename: Bruno
authors.initials: B
authors.lastname: Hoen
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000821:virology*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D010949:Plasma / Q000821:virology; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D019562:Viral Load; D014766:Viremia
chemical_list: D044966:Anti-Retroviral Agents; D017320:HIV Protease Inhibitors