title: HIV-1 Very Low Level Viremia Is Associated with Virological Failure in Highly Active Antiretroviral Treatment-Treated Patients.
abstract: The aim of this study was to evaluate the impact of HIV-1 very low-level viremia (<50 copies/ml) on the 2-year risk of virological failure. A retrospective analysis including HIV-positive patients presenting two consecutive HIV RNA below 50 copies/ml (outpatient clinic in Italy, first semester of 2010) was performed. HIV RNA was measured through real time polymerase chain reaction (PCR) assay CAP/CTM HIV-1 version 2.0 (detection limit: 20 copies/ml) and stratified as undetectable RNA ("Target Not Detected", TND), <20 copies/ml, 20-50 copies/ml. After 96 weeks virological failure was defined as two consecutive viral loads above 50 copies/ml. Log-rank tests and a multivariate Cox proportional hazard model were used for univariate and multivariate analysis. A total of 1,055 patients (71.4% male, 87.4% white, aged 46.7 years) were included: nadir and current CD4 cell counts were 203 cells/mm(3) (106-292) and 554 cells/mm(3) (413-713.5). HIV RNA was undetectable in 781 patients (74%), <20 copies/ml in 190 patients (18%) and 20-50 copies/ml in 84 patients (8%). Virological failure was observed in 81 patients (7.7%); at multivariate analysis detectable RNA at baseline (p=0.017), HCV infection (p=0.020), more than three pills in the regimen (p=0.003), and duration of HIV RNA <50 copies/ml below 2 years (p<0.001) were independently associated with virological failure. In 14 patients newly selected resistance-associated mutations were observed. Undetectable HIV RNA by real-time PCR is significantly associated with a lower 2-year risk of virological failure along with Ab HCV negativity, longer viral control, and lower pill burden. Studies investigating the management of residual viremia under antiretroviral treatment are warranted.
authors.affiliation: 1 Unit of Infectious Diseases, Department of Medical Sciences, University of Torino , Torino, Italy .
authors.forename: Andrea
authors.initials: A
authors.lastname: Calcagno
authors.affiliation: 1 Unit of Infectious Diseases, Department of Medical Sciences, University of Torino , Torino, Italy .
authors.forename: Ilaria
authors.initials: I
authors.lastname: Motta
authors.affiliation: 2 Laboratory of Microbiology and Molecular Biology , Ospedale Amedeo di Savoia, Torino, Italy .
authors.forename: Valeria
authors.initials: V
authors.lastname: Ghisetti
authors.affiliation: 1 Unit of Infectious Diseases, Department of Medical Sciences, University of Torino , Torino, Italy .
authors.forename: Salvatore
authors.initials: S
authors.lastname: Lo Re
authors.affiliation: 2 Laboratory of Microbiology and Molecular Biology , Ospedale Amedeo di Savoia, Torino, Italy .
authors.forename: Tiziano
authors.initials: T
authors.lastname: Allice
authors.affiliation: 1 Unit of Infectious Diseases, Department of Medical Sciences, University of Torino , Torino, Italy .
authors.forename: Letizia
authors.initials: L
authors.lastname: Marinaro
authors.affiliation: 2 Laboratory of Microbiology and Molecular Biology , Ospedale Amedeo di Savoia, Torino, Italy .
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Milia
authors.affiliation: 1 Unit of Infectious Diseases, Department of Medical Sciences, University of Torino , Torino, Italy .
authors.forename: Maria C
authors.initials: MC
authors.lastname: Tettoni
authors.affiliation: 1 Unit of Infectious Diseases, Department of Medical Sciences, University of Torino , Torino, Italy .
authors.forename: Laura
authors.initials: L
authors.lastname: Trentini
authors.affiliation: 3 Unit of Infectious Diseases, "Divisione A," Ospedale Amedeo di Savoia , Torino, Italy .
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Orofino
authors.affiliation: 1 Unit of Infectious Diseases, Department of Medical Sciences, University of Torino , Torino, Italy .
authors.forename: Bernardino
authors.initials: B
authors.lastname: Salassa
authors.affiliation: 1 Unit of Infectious Diseases, Department of Medical Sciences, University of Torino , Torino, Italy .
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Perri
authors.affiliation: 1 Unit of Infectious Diseases, Department of Medical Sciences, University of Torino , Torino, Italy .
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonora
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D056808:Biostatistics; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies; D017211:Treatment Failure; D019562:Viral Load; D014766:Viremia
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral