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Durability of viral suppression with first-line antiretroviral therapy in patients with HIV in the UK: an observational cohort study

2017; Elsevier BV; Volume: 4; Issue: 7 Linguagem: Inglês

10.1016/s2352-3018(17)30053-x

2405-4704

Jemma L. O’Connor, Colette Smith, Fiona Lampe, Margaret Johnson, David R. Chadwick, Mark Nelson, David Dunn, Alan Winston, Frank A. Post, Caroline Sabin, Andrew Phillips, Jonathan Ainsworth, Sris Allan, Jane Anderson, Abdel Babiker, David Chadwick, Valérie Delpech, David Dunn, Martin Fisher, Brian Gazzard, Richard Gilson, Mark Gompels, Phillip Hay, Teresa Hill, Margaret Johnson, Sophie José, Stephen Kegg, Clifford Leen, Fabiola Martin, Mark Nelson, Chloe Orkin, Adrian Palfreeman, Andrew Phillips, Deenan Pillay, Frank A. Post, Jillian Pritchard, Caroline Sabin, Memory Sachikonye, Achim Schwenk, Anjum Tariq, Roy Trevelion, John Walsh, Adam Glabay, Nicky Perry, Stuart Tilbury, Elaney Youssef, Duncan Churchill, Brian Gazzard, Mark Nelson, Russell J. Everett, David Asboe, Sundhiya Mandalia, Frank A. Post, Hardik Korat, Chris Taylor, Zachary Gleisner, Fowzia Ibrahim, Linda Campbell, Richard Gilson, Nataliya Brima, Ian Williams, Margaret Johnson, M Youle, Fiona Lampe, Colette Smith, Rob Tsintas, Clinton Chaloner, Sharon Hutchinson, Caroline Sabin, Andrew Phillips, Teresa Hill, Sophie José, A. Thornton, Susie Huntington, Joan Walsh, Nicky Mackie, Alan Winston, Jonathan Weber, Farhan Ramzan, Melanie Carder, Chloe Orkin, Janet Lynch, James Hand, Cintya de Oliveira Souza, Jane Anderson, Sajid Munshi, Jonathan Ainsworth, Achim Schwenk, Sheila Miller, C Wood, Clifford Leen, Andrew Wilson, Sheila Morris, Mark Gompels, Sophie Allan, Adrian Palfreeman, Khairuddin Memon, Adam Lewszuk, David Chadwick, Emily K. Cope, James J. Gibson, Stephen Kegg, Patricia A. Main, Sue Mitchell, Matthew F. Hunter, Mandeep Singh Dhillon, Fabiola Martin, Sarah Russell-Sharpe, Sophie Allan, A. L. Harte, Sue Clay, A Tariq, Horace J. Spencer, Ron Jones, Jessica Pritchard, Shirley Cumming, Claire Atkinson, Valérie Delpech,

HIV Research and Treatment

BackgroundThe length of time that people with HIV on antiretroviral therapy (ART) with viral load suppression will be able to continue before developing viral rebound is unknown. We aimed to investigate the rate of first viral rebound in people that have achieved initial suppression with ART, to determine factors associated with viral rebound, and to use these estimates to predict long-term durability of viral suppression.MethodsThe UK Collaborative HIV Cohort (UK CHIC) Study is an ongoing multicentre cohort study that brings together in a standardised format data on people with HIV attending clinics around the UK. We included participants who started ART with three or more drugs and who had achieved viral suppression (≤50 copies per mL) by 9 months after the start of ART (baseline). Viral rebound was defined as the first single viral load of more than 200 copies per mL or treatment interruption (for ≥1 month). We investigated factors associated with viral rebound with Poisson regression. These results were used to calculate the rate of viral rebound according to several key factors, including age, calendar year at start of ART, and time since baseline.ResultsOf the 16 101 people included, 4519 had a first viral rebound over 58 038 person-years (7·8 per 100 person-years, 95% CI 7·6–8·0). Of the 4519 viral rebounds, 3105 (69%) were defined by measurement of a single viral load of more than 200 copies per mL, and 1414 (31%) by a documented treatment interruption. The rate of first viral rebound declined substantially over time until 7 years from baseline. The other factors associated with viral rebound were current age at follow-up and calendar year at ART initiation (p<0·0001) and HIV risk group (p<0·0001); higher pre-ART CD4 count (p=0·0008) and pre-ART viral load (p=0·0003) were associated with viral rebound in the multivariate analysis only. For 1322 (29%) of the 3105 people with observed viral rebound, the next viral load value after rebound was 50 copies per mL or less with no regimen change. For HIV-positive men who have sex with men, our estimates suggest that the probability of first viral rebound reaches a plateau of 1·4% per year after 45 years of age, and 1·0% when accounting for the fact that 29% of viral rebounds are temporary elevations.InterpretationA substantial proportion of people on ART will not have viral rebound over their lifetime, which has implications for people with HIV and the planning of future drug development.FundingUK Medical Research Council.