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Abstract
CLINICAL COURSE OF HIV-INFECTED PATIENTS WITH DETECTABLE VIREMIA WHILE ON ANTIRETROVIRAL THERAPY
TENORIO A, SMITH K, SHA B, KURITZKES D, LANDAY A, KESSLER H
Objective: 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.
The 1st. IAS Conference on HIV Pathogenesis and Treatment
Abstract no.
17
Suggested Citation
"TENORIOA, et al.
CLINICAL COURSE OF HIV-INFECTED PATIENTS WITH DETECTABLE VIREMIA WHILE ON ANTIRETROVIRAL THERAPY.
Oral Presentation:
The 1st. IAS Conference on HIV Pathogenesis and Treatment
:
Abstract no.
17"
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