Plasma HIV viral rebound following protocol-indicated cessation of ART commenced in primary and chronic HIV infection

Hamlyn, Elizabeth, Ewings, Fiona M, Porter, Kholoud, Cooper, David A, Tambussi, Giuseppe, Schechter, Mauro, Pedersen, Court, Okulicz, Jason F, McClure, Myra, Babiker, Abdel, Weber, Jonathan, Fidler, Sarah, Fisher, Martin and The INSIGHT SMART and SPARTAC Investigators, (2012) Plasma HIV viral rebound following protocol-indicated cessation of ART commenced in primary and chronic HIV infection. PloS one, 7 (8). e43754. ISSN 1932-6203

[img]
Preview
PDF - Published Version
Available under License Creative Commons Attribution.

Download (269kB) | Preview

Abstract

OBJECTIVES

The magnitude of HIV viral rebound following ART cessation has consequences for clinical outcome and onward transmission. We compared plasma viral load (pVL) rebound after stopping ART initiated in primary (PHI) and chronic HIV infection (CHI).

DESIGN

Two populations with protocol-indicated ART cessation from SPARTAC (PHI, n = 182) and SMART (CHI, n = 1450) trials.

METHODS

Time for pVL to reach pre-ART levels after stopping ART was assessed in PHI using survival analysis. Differences in pVL between PHI and CHI populations 4 weeks after stopping ART were examined using linear and logistic regression. Differences in pVL slopes up to 48 weeks were examined using linear mixed models and viral burden was estimated through a time-averaged area-under-pVL curve. CHI participants were categorised by nadir CD4 at ART stop.

RESULTS

Of 171 PHI participants, 71 (41.5%) rebounded to pre-ART pVL levels, at a median of 50 (95% CI 48-51) weeks after stopping ART. Four weeks after stopping treatment, although the proportion with pVL ≥ 400 copies/ml was similar (78% PHI versus 79% CHI), levels were 0.45 (95% CI 0.26-0.64) log(10) copies/ml lower for PHI versus CHI, and remained lower up to 48 weeks. Lower CD4 nadir in CHI was associated with higher pVL after ART stop. Rebound for CHI participants with CD4 nadir >500 cells/mm(3) was comparable to that experienced by PHI participants.

CONCLUSIONS

Stopping ART initiated in PHI and CHI was associated with viral rebound to levels conferring increased transmission risk, although the level of rebound was significantly lower and sustained in PHI compared to CHI.

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Brighton and Sussex Medical School
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine > RA0643 Communicable diseases and public health > RA0644 Individual diseases or groups of diseases, A-Z > RA0644.A25 AIDS. HIV infections
Related URLs:
Depositing User: Ellen Thomas
Date Deposited: 25 Nov 2013 15:59
Last Modified: 23 Mar 2017 18:37
URI: http://sro.sussex.ac.uk/id/eprint/47144

View download statistics for this item

📧 Request an update