[17] CLINICAL COURSE OF HIV-INFECTED PATIENTS WITH DETECTABLE VIREMIA WHILE ON ANTIRETROVIRAL THERAPY

1st International AIDS Society Conference on HIV Pathogenesis and Treatment

Buenos Aires, Argentina - July 8-11, 2001

[TITLE:] CLINICAL COURSE OF HIV-INFECTED PATIENTS WITH DETECTABLE VIREMIA WHILE ON ANTIRETROVIRAL THERAPY

[AUTHOR(S):] Tenorio A, Smith K, Sha B, Kuritzkes D, Landay A, Kessler H
Rush Medical College, Chicago, IL, USA

IAS Conf HIV Pathog Treat 2001 Jul 8-11;1st: Abstract No. 17

[ABSTRACT:] Background: To characterize the clinical, immunologic and virologic course of HIV-infected patients on antiretroviral therapy (ART) with stable detectable viremia (viral load or VL: 50-10,000 copies/ml) for > 6 months (plateau subjects or P).

Methods: Clinic charts at an urban-based university HIV clinic with 600 patients were reviewed and 25 P identified. For comparison, 12 patients with VL > 10,000 copies/ml for >/= 6 months (F) and 10 patients with undetectable VL >/= 6 months (U) were randomly identified. The number of opportunistic events (OE/ infections or malignancies), changes in ART regimen and CD4 cell counts were compared. Lymphoproliferative (LPA) responses to HIV p24 Ag were determined per standard protocol (stimulation index > 10 as +). HIV-1 reverse transcriptase (RT) and protease (PR) genotypes from P and F patients were determined using the TrueGene Assay (Visible Genetics) at 2 time points 3 - 6 months apart. Primary and secondary mutations were counted. Number of new mutations was determined by counting the codon changes (either addition or loss) in RT and PR between 2 samples.

Results: Over 42 months, CD4 cell counts increased in U, P and F subjects by a median of 365, 64 and 2 cells/uL respectively (p: 0.01 for U vs P, 0.02 for U vs F and 0.81 for P vs F). The proportion of subjects with OE in U, P and F were 0/12, 0/25 and 6/12 (p<0.001) subjects. The median number of ART changes in U, P and F were 1, 2 and 6. Virus from P and F had 1.0 +/- 0.3 and 2.3 +/- 0.4 new mutations (p=0.003) over 3 - 6 months. Proportions of + LPA in U, P and F were 5/10, 8/25 and 0/12 subjects.

Conclusions: HIV-infected patients on ART have increases in CD4 cell counts even with detectable viremia. U and P subjects had fewer OE than F subjects. The magnitude of these benefits is related to the level of viremia. Virus from P subjects accumulated fewer resistance mutations than F patients despite having persistent viremia and being on the same ART regimen.

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