title: Low-level viraemia, measured as viraemia copy-years, as a prognostic factor for medium-long-term all-cause mortality: a MASTER cohort study.
abstract: We investigated the association between persistent low-level viraemia, measured as viraemia copy-years (VCY), and all-cause mortality.
  
  
  
  We included 3271 HIV-infected patients who initiated their first combined ART (cART) during 1998-2012 enrolled in the multicentre Italian MASTER cohort. VCY was defined as the area under the curve of plasma viral load (pVL) and expressed in log10copies · years/mL. VCY was evaluated from cART initiation until the end of follow-up [VCY-overall (VCY-o)], and stratified into before [VCY-early (VCY-e)] and after [VCY-late (VCY-l)] the eighth month from starting cART, and as the ratio of VCY-l to follow-up duration (VCY-l/FUD).
  
  
  
  The risk of death increased of about 40% for higher than the median levels of VCY-o and VCY-e. Compared with subjects with permanently suppressed pVL after the eighth month from starting cART, mortality increased by 70% for those with VCY-l ≥3 log10copies·years/mL, and by about 20-fold for those with VCY-l/FUD ≥2.3 log10copies/mL. Patients who maintained low levels of VCY-l (<3 log10copies · years/mL) or VCY-l/FUD (<2.3 log10copies/mL) had a risk of death similar to patients with permanently suppressed pVL. CD4 cell count at baseline was predictive of high risk of death only in subjects with VCY-l ≥3 log10copies · years/mL.
  
  
  
  The risk of death did not increase in HIV-infected patients with low levels of VCY-l compared with patients with permanent virological suppression.
authors.affiliation: University Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Italy.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Quiros-Roldan
authors.affiliation: Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy elena.raffetti@gmail.com.
authors.forename: Elena
authors.initials: E
authors.lastname: Raffetti
authors.affiliation: University Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Castelli
authors.affiliation: University Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Focà
authors.affiliation: Hospital Division of Infectious and Tropical Diseases, Brescia Spedali Civili General Hospital, Brescia, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Castelnuovo
authors.affiliation: Clinical Infectious Diseases of 'Azienda Ospedaliera S. M. Annunziata' of Firenze, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Di Pietro
authors.affiliation: Institute of Clinical Infectious Diseases of Catholic University of Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Gagliardini
authors.affiliation: Clinic of Infectious Diseases, San Gerardo de' Tintori Hospital, Monza, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gori
authors.affiliation: Clinic of Infectious Diseases, University of Bari, Bari, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Saracino
authors.affiliation: Clinical Infectious Diseases of 'Istituti Ospitalieri' of Cremona, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Fornabaio
authors.affiliation: Clinical Infectious Diseases of 'Azienda Ospedaliera S. Anna' of Ferrara, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Sighinolfi
authors.affiliation: Clinical Infectious Diseases of 'Ospedale Papa Giovanni XXIII' of Bergamo, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Di Filippo
authors.affiliation: Clinical Infectious Diseases of 'Ospedale Papa Giovanni XXIII' of Bergamo, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Maggiolo
authors.affiliation: Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Donato
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D019562:Viral Load; D014766:Viremia / Q000401:mortality*; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents