Predicting Viral Failure in Human Immunodeficiency Virus Perinatally Infected Youth With Persistent Low-Level Viremia on Highly Active Antiretroviral Therapy
Less than optimal adherence with antiretroviral therapy occurs commonly among human immunodeficiency virus HIV)-infected youth. In this study, our object was to identify patterns in the prefailure measurement of viral load (VL) that can reliably predict virological failure (VF) in HIV perinatally in...
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Published in | Journal of the Pediatric Infectious Diseases Society Vol. 8; no. 4; pp. 303 - 309 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
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England
Oxford University Press
25.09.2019
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Abstract | Less than optimal adherence with antiretroviral therapy occurs commonly among human immunodeficiency virus HIV)-infected youth. In this study, our object was to identify patterns in the prefailure measurement of viral load (VL) that can reliably predict virological failure (VF) in HIV perinatally infected youth on highly active antiretroviral therapy (HAART).
We conducted a retrospective chart review of HIV-infected youth with low-level viremia (LLV), defined as an HIV VL between the lower limits of detection (20-75 copies/mL) and 1000 copies/mL. All patients were perinatally infected, under 22 years of age, observed for at least 24 months of consecutive follow-up between May 2008 and July 2014, and received their HIV care at the University of Miami Miller School of Medicine. Of the 349 subjects screened, 100 were eligible for analysis. Virological failure was defined as 3 or more consecutive VLs greater than 1000 copies/mL. Multiple logistic regression and receiver operator characteristic curves were used to identify patterns in VL that ultimately resulted in VF.
Fifteen of the 100 patients experienced VF. Higher log10 mean VL, positive slope of the VL (log10 copies/mL per day), and fewer clinic visits were associated with a higher probability of VF. Sensitivity and specificity were .87 and .95, respectively. Resistance was not found in 12 of 15 patients with VF.
Patients with LLV that had fewer clinic visits and a trend toward increasing VLs had an increased risk of VF. Noncompliance seems to be a major component of VF. Physicians should emphasize the critical nature of medication adherence. |
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AbstractList | BACKGROUNDLess than optimal adherence with antiretroviral therapy occurs commonly among human immunodeficiency virus HIV)-infected youth. In this study, our object was to identify patterns in the prefailure measurement of viral load (VL) that can reliably predict virological failure (VF) in HIV perinatally infected youth on highly active antiretroviral therapy (HAART). METHODSWe conducted a retrospective chart review of HIV-infected youth with low-level viremia (LLV), defined as an HIV VL between the lower limits of detection (20-75 copies/mL) and 1000 copies/mL. All patients were perinatally infected, under 22 years of age, observed for at least 24 months of consecutive follow-up between May 2008 and July 2014, and received their HIV care at the University of Miami Miller School of Medicine. Of the 349 subjects screened, 100 were eligible for analysis. Virological failure was defined as 3 or more consecutive VLs greater than 1000 copies/mL. Multiple logistic regression and receiver operator characteristic curves were used to identify patterns in VL that ultimately resulted in VF. RESULTSFifteen of the 100 patients experienced VF. Higher log10 mean VL, positive slope of the VL (log10 copies/mL per day), and fewer clinic visits were associated with a higher probability of VF. Sensitivity and specificity were .87 and .95, respectively. Resistance was not found in 12 of 15 patients with VF. CONCLUSIONSPatients with LLV that had fewer clinic visits and a trend toward increasing VLs had an increased risk of VF. Noncompliance seems to be a major component of VF. Physicians should emphasize the critical nature of medication adherence. Less than optimal adherence with antiretroviral therapy occurs commonly among human immunodeficiency virus HIV)-infected youth. In this study, our object was to identify patterns in the prefailure measurement of viral load (VL) that can reliably predict virological failure (VF) in HIV perinatally infected youth on highly active antiretroviral therapy (HAART). We conducted a retrospective chart review of HIV-infected youth with low-level viremia (LLV), defined as an HIV VL between the lower limits of detection (20-75 copies/mL) and 1000 copies/mL. All patients were perinatally infected, under 22 years of age, observed for at least 24 months of consecutive follow-up between May 2008 and July 2014, and received their HIV care at the University of Miami Miller School of Medicine. Of the 349 subjects screened, 100 were eligible for analysis. Virological failure was defined as 3 or more consecutive VLs greater than 1000 copies/mL. Multiple logistic regression and receiver operator characteristic curves were used to identify patterns in VL that ultimately resulted in VF. Fifteen of the 100 patients experienced VF. Higher log10 mean VL, positive slope of the VL (log10 copies/mL per day), and fewer clinic visits were associated with a higher probability of VF. Sensitivity and specificity were .87 and .95, respectively. Resistance was not found in 12 of 15 patients with VF. Patients with LLV that had fewer clinic visits and a trend toward increasing VLs had an increased risk of VF. Noncompliance seems to be a major component of VF. Physicians should emphasize the critical nature of medication adherence. |
Author | Mathew, Sunil Flores, Claudia Gonzalez, Ivan Ludwig, David A Rivera-Hernandez, Delia Mitchell, Charles D Pereira, Ruth Scott, Gwendolyn B Dominguez, Sady |
AuthorAffiliation | 1 Department of Pediatrics, Division of Infectious Disease and Immunology , Florida 2 Department of Pediatrics, Division of Pediatric Clinical Research, Department of Public Health Sciences (Biostatistics), University of Miami-Miller School of Medicine , Florida |
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Copyright | The Author(s) 2018. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. The Author(s) 2018. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 2018 |
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References | Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children (2020101712044788400_CIT0001) Pilcher (2020101712044788400_CIT0009) 1999; 13 García-Gascó (2020101712044788400_CIT0014) 2008; 61 Vandenhende (2020101712044788400_CIT0003) 2015; 29 Castro (2020101712044788400_CIT0015) 2011; 377 Boillat-Blanco (2020101712044788400_CIT0004) 2015; 20 Kantor (2020101712044788400_CIT0013) 2004; 18 Ribaudo (2020101712044788400_CIT0002) Laprise (2020101712044788400_CIT0005) 2013; 57 Vandenhende (2020101712044788400_CIT0006) 2015; 20 Ruel (2020101712044788400_CIT0012) 2011; 56 Karlsson (2020101712044788400_CIT0007) 2004; 18 Panel on Antiretroviral Guidelines for Adults and Adolescents (2020101712044788400_CIT0008) Kieffer (2020101712044788400_CIT0010) 2004; 189 Nettles (2020101712044788400_CIT0011) 2005; 293 |
References_xml | – volume: 377 start-page: 1580 year: 2011 ident: 2020101712044788400_CIT0015 article-title: Risk of triple-class virological failure in children with HIV: a retrospective cohort study publication-title: Lancet doi: 10.1016/S0140-6736(11)60208-0 contributor: fullname: Castro – volume: 18 start-page: 981 year: 2004 ident: 2020101712044788400_CIT0007 article-title: Immunologic and virologic evolution during periods of intermittent and persistent low-level viremia publication-title: AIDS doi: 10.1097/00002030-200404300-00005 contributor: fullname: Karlsson – volume: 189 start-page: 1452 year: 2004 ident: 2020101712044788400_CIT0010 article-title: Genotypic analysis of HIV-1 drug resistance at the limit of detection: virus production without evolution in treated adults with undetectable HIV loads publication-title: J Infect Dis doi: 10.1086/382488 contributor: fullname: Kieffer – volume: 29 start-page: 373 year: 2015 ident: 2020101712044788400_CIT0003 article-title: Impact of low-level viremia on clinical and virological outcomes in treated HIV-1-infected patients publication-title: AIDS doi: 10.1097/QAD.0000000000000544 contributor: fullname: Vandenhende – volume: 20 start-page: 655 year: 2015 ident: 2020101712044788400_CIT0006 article-title: Risk of virological failure in HIV-1-infected patients experiencing low level viraemia under active antiretroviral therapy (ANRS C03 cohort study) publication-title: Antivir Ther doi: 10.3851/IMP2949 contributor: fullname: Vandenhende – volume: 61 start-page: 699 year: 2008 ident: 2020101712044788400_CIT0014 article-title: Episodes of low-level viral rebound in HIV-infected patients on antiretroviral therapy: frequency, predictors and outcome publication-title: J Antimicrob Chemother doi: 10.1093/jac/dkm516 contributor: fullname: García-Gascó – ident: 2020101712044788400_CIT0008 contributor: fullname: Panel on Antiretroviral Guidelines for Adults and Adolescents – volume: 56 start-page: 44 year: 2011 ident: 2020101712044788400_CIT0012 article-title: Early virologic failure and the development of antiretroviral drug resistance mutations in HIV-infected Ugandan children publication-title: J Acquir Immune Defic Syndr doi: 10.1097/QAI.0b013e3181fbcbf7 contributor: fullname: Ruel – ident: 2020101712044788400_CIT0002 article-title: Virologic failure endpoint definition in clinical trials: is using HIV-1 RNA threshold <200 copies/mL better than <50 copies/mL; an analysis of ACTG Studies. #580 contributor: fullname: Ribaudo – volume: 18 start-page: 1503 year: 2004 ident: 2020101712044788400_CIT0013 article-title: Evolution of resistance to drugs in HIV-1-infected patients failing antiretroviral therapy publication-title: AIDS doi: 10.1097/01.aids.0000131358.29586.6b contributor: fullname: Kantor – volume: 57 start-page: 1489 year: 2013 ident: 2020101712044788400_CIT0005 article-title: Virologic failure following persistent low-level viremia in a cohort of HIV-positive patients: results from 12 years of observation publication-title: Clin Infect Dis doi: 10.1093/cid/cit529 contributor: fullname: Laprise – volume: 13 start-page: 1337 year: 1999 ident: 2020101712044788400_CIT0009 article-title: Detectable HIV-1 RNA at levels below quantifiable limits by amplicor HIV-1 monitor is associated with virologic relapse on antiretroviral therapy publication-title: AIDS doi: 10.1097/00002030-199907300-00010 contributor: fullname: Pilcher – volume: 20 start-page: 165 year: 2015 ident: 2020101712044788400_CIT0004 article-title: Virological outcome and management of persistent low-level viraemia in HIV-1-infected patients: 11 years of the Swiss HIV Cohort Study publication-title: Antivir Ther doi: 10.3851/IMP2815 contributor: fullname: Boillat-Blanco – volume: 293 start-page: 817 year: 2005 ident: 2020101712044788400_CIT0011 article-title: Intermittent HIV-1 viremia (Blips) and drug resistance in patients receiving HAART publication-title: JAMA doi: 10.1001/jama.293.7.817 contributor: fullname: Nettles – ident: 2020101712044788400_CIT0001 contributor: fullname: Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children |
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Snippet | Less than optimal adherence with antiretroviral therapy occurs commonly among human immunodeficiency virus HIV)-infected youth. In this study, our object was... BACKGROUNDLess than optimal adherence with antiretroviral therapy occurs commonly among human immunodeficiency virus HIV)-infected youth. In this study, our... |
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SubjectTerms | Adolescent Anti-HIV Agents - therapeutic use Antiretroviral Therapy, Highly Active - methods Child Female HIV Infections - drug therapy Humans Logistic Models Male Original Retrospective Studies Viral Load Viremia - drug therapy Viremia - virology |
Title | Predicting Viral Failure in Human Immunodeficiency Virus Perinatally Infected Youth With Persistent Low-Level Viremia on Highly Active Antiretroviral Therapy |
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