Predictors of incomplete viral response and virologic failure in patients with acute and early HIV infection. Results of Italian Network of ACuTe HIV InfectiON (INACTION) cohort

• Published in: HIV medicine Vol. 21; no. 8; pp. 523 - 535
• Main Authors: Taramasso, L, Fabbiani, M, Nozza, S, De Benedetto, I, Bruzzesi, E, Mastrangelo, A, Pinnetti, C, Calcagno, A, Ferrara, M, Bozzi, G, Focà, E, Quiros‐Roldan, E, Ripamonti, D, Campus, M, Celesia, BM, Torti, C, Cosco, L, Di Biagio, A, Rusconi, S, Marchetti, G, Mussini, C, Gulminetti, R, Cingolani, A, d’Ettorre, G, Madeddu, G, Franco, A, Orofino, G, Squillace, N, Muscatello, A, Gori, A, Antinori, A, Tambussi, G, Bandera, A
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.09.2020
• Subjects: acute HIV infection; Antiretroviral agents; Antiretroviral therapy; blip; CD4 antigen; CD8 antigen; Central nervous system; Confidence intervals; Drugs; early antiretroviral treatment; HIV; Human immunodeficiency virus; incomplete viral response; Infections; Regression analysis; Ribonucleic acid; RNA; Statistical analysis; virologic failure; acute HIV infection; incomplete viral response; virologic failure; early antiretroviral treatment; blip
• ISSN: 1464-2662; 1468-1293
• DOI: 10.1111/hiv.12885

Objectives The aim of this study was to evaluate the factors that can influence an incomplete viral response (IVR) after acute and early HIV infection (AEHI). Methods This was a retrospective, observational study including patients with AEHI (Fiebig stages I–V) diagnosed between January 2008 and December 2014 at 20 Italian centres. IVR was defined by: (1) viral blip (51–1000 HIV‐1 RNA copies/mL after achievement of < 50 HIV‐1 RNA copies/mL); (2) virologic failure [> 1000 copies/mL after achievement of < 200 copies/mL, or ≥ 200 copies/mL after 24 weeks on an antiretroviral therapy (ART)]; (3) suboptimal viral response (> 50 copies/mL after 48 weeks on ART or two consecutive HIV‐1 RNA levels with ascending trend during ART). Cox regression analysis was used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for IVR. Results In all, 263 patients were studied, 227 (86%) males, with a median [interquartile range (IQR)] age of 38 (30–46) years. During a median follow‐up of 13.0 (5.7–31.1) months, 38 (14.4%) had IVR. The presence of central nervous system (CNS) symptoms was linked to a higher risk of IVR (HR = 4.70, 95% CI: 1.56–14.17), while a higher CD4/CD8 cell count ratio (HR = 0.13, 95% CI: 0.03–0.51 for each point increase) and first‐line ART with three‐drug regimens recommended by current guidelines (HR = 0.40, 95% CI: 0.18–0.91 compared with other regimens including four or five drugs, older drugs or non‐standard backbones) were protective against IVR. Conclusions Patients with lower CD4/CD8 ratio and CNS symptoms could be at a higher risk of IVR after AEHI. The use of recommended ART may be relevant for improving short‐term viral efficacy in this group of patients.