Ultrasensitive assessment of residual HIV viraemia in HAART-treated patients with persistently undetectable plasma HIV-RNA: A cross-sectional evaluation
✍ Scribed by Stefano Bonora; Emanuele Nicastri; Andrea Calcagno; Daniel Gonzalez de Requena; Gabriella D'Ettorre; Loredana Sarmati; Lucia Palmisano; Vincenzo Vullo; Giovanni Di Perri; Massimo Andreoni
- Book ID
- 102380030
- Publisher
- John Wiley and Sons
- Year
- 2009
- Tongue
- English
- Weight
- 95 KB
- Volume
- 81
- Category
- Article
- ISSN
- 0146-6615
No coin nor oath required. For personal study only.
✦ Synopsis
Abstract
Improvements in HIV‐RNA assays have made accurate detection of as few as 2 copies/ml possible. This study objective was the evaluation of ultrasensitive HIV‐RNA quantitation (beneath current threshold: 50 copies/ml) in patients receiving different antiretroviral regimens. A cross‐sectional, ultrasensitive measurement of HIV‐RNA levels (detection limit: 2.5 HIV‐RNA copies/ml) was performed in 154 HIV‐1‐infected patients receiving ARV therapy, all classed as full responders according to the 50 copies/ml cut‐off. Patients were undergoing treatment with two nucleoside/nucleotide reverse transcriptase inhibitors (N/NtRTIs) plus nevirapine (NVP, n = 48), efavirenz (EFV, n = 57) or lopinavir/ritonavir (LPV/r, n = 49). Undetectable HIV‐RNA (<2.5 copies/ml) occurred in 29/48 (60.4%), 24/57 (42.1%) and 14/49 (28.6%) NVP, EFV and LPV/r recipients, respectively. Mean virological‐suppression (<50 copies/ml) duration was 28.6 months (median = 22, SD = 17.8), and only in LPV/r recipients length of suppression was associated with significantly lower HIV‐RNA levels (P = 0.015). Mean nadir CD4+ cell count of 270 cells/mm^3^ (median = 240, SD = 194.5) was significantly lower in the LPV/r arm (P < 0.001). Nadir CD4+ level correlated with virological suppression but had opposite trends between NVP (positive) and LPV/r (negative; two tailed P = 0.01). Logistic regression analysis showed NVP was the only independent factor associated with virologic suppression. NVP has demonstrated a distinct virological advantage at sub‐clinical viral loads, possibly due to its greater penetration in extra‐vascular compartments, warranting further investigation in the context of persistent low‐level viraemia in long‐term HAART. J. Med. Virol. 81:400–405, 2009. © 2009 Wiley‐Liss, Inc.