Impact of pre-antiretroviral treatment HIV-RNA on time to successful virological suppression and subsequent virological failure - two nationwide, population-based cohort studies
Journal article, 2023
BACKGROUND:
The impact of pre-antiretroviral treatment (ART) HIV-RNA on time to successful virological suppression and subsequent failure in HIV patients remains poorly investigated.
METHODS:
We used the Swedish InfCareHIV database and the Danish HIV Cohort Study to evaluate impact of pre-ART HIV-RNA on primary virological suppression (HIV-RNA < 50 copies/ml) and risk of secondary virological failure (two consecutive HIV-RNA > 200 copies/ml or one >1000 copies/ml). The study included 3366 Swedish and 2050 Danish ART naïve individuals who initiated ART in the period 2000-2018. We used Kaplan-Meier estimates and Cox regression analyses to estimate absolute risks and hazard ratios.
RESULTS:
In both cohorts, more than 95% of patients with a pre-ART HIV-RNA <100 000 copies/ml obtained virological suppression within the first year after ART initiation contrasting 74% (Sweden) and 86% (Denmark) in those with HIV-RNA >1 000 000 copies/ml. Almost all patients obtained virological suppression after four years irrespective of pre-ART HIV-RNA. In contrast, we observed no substantial impact of pre-ART HIV-RNA on risk of virological failure once virological suppression was obtained.
CONCLUSION:
High pre-ART HIV-RNA is strongly associated with increased time to successful virological suppression, but pre-ART HIV-RNA has no impact on risk of subsequent virological failure.
The impact of pre-antiretroviral treatment (ART) HIV-RNA on time to successful virological suppression and subsequent failure in HIV patients remains poorly investigated.
METHODS:
We used the Swedish InfCareHIV database and the Danish HIV Cohort Study to evaluate impact of pre-ART HIV-RNA on primary virological suppression (HIV-RNA < 50 copies/ml) and risk of secondary virological failure (two consecutive HIV-RNA > 200 copies/ml or one >1000 copies/ml). The study included 3366 Swedish and 2050 Danish ART naïve individuals who initiated ART in the period 2000-2018. We used Kaplan-Meier estimates and Cox regression analyses to estimate absolute risks and hazard ratios.
RESULTS:
In both cohorts, more than 95% of patients with a pre-ART HIV-RNA <100 000 copies/ml obtained virological suppression within the first year after ART initiation contrasting 74% (Sweden) and 86% (Denmark) in those with HIV-RNA >1 000 000 copies/ml. Almost all patients obtained virological suppression after four years irrespective of pre-ART HIV-RNA. In contrast, we observed no substantial impact of pre-ART HIV-RNA on risk of virological failure once virological suppression was obtained.
CONCLUSION:
High pre-ART HIV-RNA is strongly associated with increased time to successful virological suppression, but pre-ART HIV-RNA has no impact on risk of subsequent virological failure.
Author
Erik Sörstedt
Sahlgrenska University Hospital
University of Gothenburg
Malte Mose Tetens
Rigshospitalet
Staffan Nilsson
University of Gothenburg
Chalmers, Mathematical Sciences, Applied Mathematics and Statistics
Piotr Nowak
Karolinska University Hospital
Karolinska Institutet
Carl Johan Treutiger
Stockholm South General Hospital
Fredrik Månsson
Institutionen för Translationell Medicin
Lena Änghagen
Linköping University
Magnus Gisslen
University of Gothenburg
Sahlgrenska University Hospital
Niels Obel
Rigshospitalet
University of Copenhagen
Aylin Yilmaz
University of Gothenburg
Sahlgrenska University Hospital
AIDS (London, England)
02699370 (ISSN) 14735571 (eISSN)
Vol. 37 2 279-286Subject Categories
Infectious Medicine
Gastroenterology and Hepatology
DOI
10.1097/QAD.0000000000003425
PubMed
36541640