AEGiS-13IAC: The natural history and clinical significance of intermittent virological "blips" in patients who attain an initially undetectable viral load (VL) on HAART.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

The natural history and clinical significance of intermittent virological "blips" in patients who attain an initially undetectable viral load (VL) on HAART.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. WeOrB610)

Easterbrook P, Ives N, Peters B, Gazzard B
P.Easterbrook, Academic Department of HIV/GU Medicine, The Guy's, King's & St Thomas' School of Medicine, Weston Education Centre, Cutcombe Road, London SE5 9RT, United Kingdom, Tel.: +44 20 78 48 57 70, Fax: +44 20 78 48 57 69, E-mail: philippa.easterbrook@kcl.ac.uk

BACKGROUND: The prognostic significance of intermittent virological breakthrough or "blips" in patients with an otherwise undetectable VL on HAART remains unclear. We compared the outcome of patients whose VL remained below detectable limits (BLD) after initiation of HAART compared to those who experienced intermittent VL blips.

METHODS: Eligible HIV +ve patients were those who had received an initial PI or NNRTI containing regimen between 01/01/96-31/12/98 and had a VL BLD within 6 mths of starting HAART. Patients were categorised into those whose VL remained BLD (ie > = 400 copies/ml) and those who had at least 1 VL blip (>400) during follow-up. Outcomes were % with VL BLD, median CD4 cell count rise at 12 and 18 mths following HAART initiation and change or discontinuation of the initial HAART regimen.

RESULTS: Of 860 patients identified from 3 London HIV centres we performed a preliminary analysis on 137 patients with > = 12 mths follow-up after their initial VL BLD. The VL remained BLD in 77 (56%) and 60 (44%) had at least 1 VL blip during follow-up, and the level ranged from 401-1000 copies/ml in 30 (50%); 1001-5000 in 14 (23%); to >5000 in 16 (27%). The median time from undetectability to the first blip was 6 mths. At 18 mths from HAART initiation, 64% of those with VL blips had a VL BLD. The median CD4 cell count rise at 12 and 18 mths was significantly lower in those with VL blips than those whose VL remained BLD (133 cells vs 182, p = 0.03 and 155 cells vs 269, p = 0.001). A similar % of patients in the 2 groups (63%) changed or discontinued their initial HAART regimen over a median follow-up of 14 mths.

CONCLUSIONS: In this preliminary analysis, we found that patients on HAART with intermittent low-level viraemia had an impaired CD4 cell rise relative to those who maintained a VL BLD for > = 12 mths. This lends support to the adoption of a more pro-active approach to treatment intensification in these patients. An updated analysis of 24 mths follow-up will be presented.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, Viral Load, CD4 Lymphocyte Count, HIV Infections, Anti-HIV Agents, Viremia, HIV Protease Inhibitors, HIV, Bacterial Proteins, CD4-Positive T-Lymphocytes, Natural History, London, beta-lactamase-inhibitor protein, Streptomyces, Human, virology
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