[32] CLINICAL AND IMMUNOLOGIC OUTCOMES ACCORDING TO DIFFERENT LEVELS OF VIROLOGIC SUPPRESSION (VS) AFTER UNDETECTABILITY ON HAART

1st International AIDS Society Conference on HIV Pathogenesis and Treatment

Buenos Aires, Argentina - July 8-11, 2001

[TITLE:] CLINICAL AND IMMUNOLOGIC OUTCOMES ACCORDING TO DIFFERENT LEVELS OF VIROLOGIC SUPPRESSION (VS) AFTER UNDETECTABILITY ON HAART

[AUTHOR(S):] Abgrall S, Duval X, Joly V, Descamps D, Matheron S, Costagliola D
INSERM Paris, France

IAS Conf HIV Pathog Treat 2001 Jul 8-11;1st: Abstract No. 32

[ABSTRACT:] Objectives: To evaluate factors associated with a durable virologic suppression (DVS) on HAART or different levels of viral rebound (VR) and to estimate the subsequent clinical and immunologic outcomes.

Materials: Participants of the French Hospital Database on HIV with undetectability (plasma viral load (pVL)<500 cp/ml) on HAART (at least 3 antiretroviral (ARV) drugs with at least 1 protease inhibitor (PI)) started between 01/01/97 and 12/31/98, and a subsequent follow-up of at least 12 months.

Methods: Factors associated with DVS (during 1 year) were evaluated using logistic regression model. Then factors associated with 2 levels of VR, low rebound level (LRL) (increase in pVL between 500 and 5000 cp/ml) and high rebound level (HRL) (increase in pVL=5000 cp/ml), were studied comparing both groups to patients (PTS) with DVS, and PTS with LRL to PTS with HRL. Subsequent clinical failure (CF) (new AIDS-event or death) and immunologic failure (IF) (=20% decrease in CD4 compared to M12) were evaluated.

Results: 3736 patients were included, of whom 2636 had a DVS, 387 a LRL and 713 a HRL. Median CD4 was 313 and median pVL was 17000 cp/ml at HAART initiation. Median CD4 was 385 at undetectability. Factors associated with DVS were ARV naïve status, type of PI (indinavir or dual PI), lower pVL and higher CD4 at HAART initiation, delay before undetectability (<6 months), higher gain in CD4 at undetectability. These factors were also linked with a LRL when VR occured, except for indinavir that was linked with a HRL. Median variation in CD4 increased whatever the group of VS, with the lowest increase when HRL. Compared to PTS with DVS, adjusted hazard ratio (aRH) for CF and for IF were increased in PTS with HRL (aRH, 1.71; 95%CI, 0.97-3.02 and; aRH, 1.57; 95%CI, 1.34-1.83; respectively), but not in PTS with LRL (aRH, 1.18; 95%CI, 0.48-2.92 and; aRH, 1.07; 95%CI, 0.87-1.32; respectively), arguing for more conservative ARV therapeutic approach in patients with LRL.

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