Sixth International Congress Drug Therapy in HIV Infection 17-21 November, 2002 Glasgow, UK

The aims of this study were to determine the rate of virological rebound and factors associated with rebound among patients who initially responded to HAART by achieving undetectable levels of viraemia. Patients were followed from the date of initial undetectable viral load (<400, <200 or <50 copies/ ml), providing this occurred within 12 months of starting HAART, to the first of 2 consecutive viral loads above this level, or the date of last viral load measure. 1470 patients from the pan-European, observational EuroSIDA study satisfied the inclusion criteria. The incidence of rebound per 6 month period following initial suppression was calculated, and Cox models were used to determine factors related to rebound. 675 patients rebounded (45.9%); at starting HAART 1102 patients (75.0%) were treatment experienced. The rate of virological rebound decreased significantly over time; from 38.8 per 100 PYFU in the first 6 months after initial suppression to 9.8 per 100 PYFU at/after 2 years after initial suppression (p < 0.0001). The rate of rebound was significantly lower for treatment-naïve patients compared to treatment-experienced patients (overall ratio 0.59; 95% CI 0.48 - 0.72, p < 0.0001). In a multivariate Cox model, patients on 5 or more antiretrovirals were more likely to rebound than those on 3 drugs (RH 2.02, 95% CI 1.38 - 2.96, p = 0.0003), as were patients who changed regimen at any point (RH 1.43; 95% CI 1.20 - 1.69, p < 0.0001) and treatment-experienced patients (RH 1.39, 95% CI 1.10 - 1.76, p = 0.0056). Older patients were less likely to rebound, as were patients with higher current CD4 counts (both p < 0.0001). Among treatment-experienced patients, multivariate results showed that those who were able to start nucleosides they had never taken before when starting HAART were significantly less likely to rebound (RH 0.85 per new nucleoside; 95% CI 0.76 - 0.96, p = 0.0058). In conclusion, the rate of virological rebound decreased over time suggesting the greatest risk of rebound is in the first months following initial suppression. Patients on more intensive regimens and those swapping therapy were more likely to rebound, as were treatment-experienced patients. Among experienced patients, those who could add new nucleosides were at a lower risk of rebound.

Presenting author: A Mocroft

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1 HIV Research Unit, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, United Kingdom.

2 EuroSIDA Study Group.

2002-11-17
PL5-4

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