title: Younger Age Predicts Failure to Achieve Viral Suppression and Virologic Rebound Among HIV-1-Infected Persons in Serodiscordant Partnerships.
abstract: BACKGROUND
  Antiretroviral therapy (ART) markedly reduces the risk of HIV-1 transmission in serodiscordant partnerships. We previously found that younger age and higher CD4 counts were associated with delayed initiation of ART by HIV-1-infected partners in serodiscordant partnerships. Among those initiating ART, we sought to explore whether those same factors were associated with failure to achieve viral suppression.
  
  
  METHODS
  In a prospective study of HIV-1-infected persons who had a known heterosexual HIV-1-uninfected partner in Kenya and Uganda [Partners Pre-Exposure Prophylaxis (PrEP) Study], we used Cox proportional hazards regression to evaluate correlates of viral nonsuppression (HIV-1 RNA >80 copies/ml).
  
  
  RESULTS
  Of 1,035 HIV-1-infected participants initiating ART, 867 (84%) achieved viral suppression: 77% by 6 months and 86% by 12 months. Younger age [adjusted hazard ratio (aHR) 1.05 for every 5 years younger; p = .006], lower pretreatment CD4 count (aHR 1.26; p = .009 for ≤250 compared with >250 cells/μl), and higher pretreatment HIV-1 RNA quantity (aHR 1.21 per log10; p < .001) independently predicted failure to achieve viral suppression. Following initial viral suppression, 8.8% (76/867) experienced virologic rebound (HIV-1 RNA >200 copies/ml): 6.3% and 11.5% by 6 and 12 months after initial suppression, respectively. Age was the only factor associated with increased risk of virologic rebound (aHR 1.33 for every 5 years younger; p = .005).
  
  
  CONCLUSIONS
  For HIV-1-infected persons in serodiscordant couples, younger age was associated with delayed ART initiation, failure to achieve viral suppression, and increased risk of virologic rebound. Motivating ART initiation and early adherence is a key to achieving and sustaining viral suppression.
authors.affiliation: 1 Department of Global Health, University of Washington , Seattle, Washington.|2 Department of Epidemiology, University of Washington , Seattle, Washington.
authors.forename: Andrew
authors.initials: A
authors.lastname: Mujugira
authors.affiliation: 1 Department of Global Health, University of Washington , Seattle, Washington.|2 Department of Epidemiology, University of Washington , Seattle, Washington.|3 Department of Medicine, University of Washington , Seattle, Washington.
authors.forename: Connie
authors.initials: C
authors.lastname: Celum
authors.affiliation: 4 Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Jordan W
authors.initials: JW
authors.lastname: Tappero
authors.affiliation: 5 Departments of Medicine and Medical Microbiology, University of Manitoba , Winnipeg, Canada .
authors.forename: Allan
authors.initials: A
authors.lastname: Ronald
authors.affiliation: 1 Department of Global Health, University of Washington , Seattle, Washington.|6 Center for Clinical Research, Kenya Medical Research Institute , Nairobi, Kenya .
authors.forename: Nelly
authors.initials: N
authors.lastname: Mugo
authors.affiliation: 1 Department of Global Health, University of Washington , Seattle, Washington.|2 Department of Epidemiology, University of Washington , Seattle, Washington.|3 Department of Medicine, University of Washington , Seattle, Washington.
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
mesh_terms: D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D007630:Kenya; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D011446:Prospective Studies; D012747:Sexual Partners; D016896:Treatment Outcome; D014454:Uganda; D019562:Viral Load / Q000187:drug effects*
chemical_list: D019380:Anti-HIV Agents