Factors associated with a strictly undetectable viral load in HIV-1-infected patients
Article first published online: 21 MAR 2012
© 2012 British HIV Association
Volume 13, Issue 9, pages 568–573, October 2012
How to Cite
Martin-Blondel, G., Sauné, K., Vu Hai, V., Marchou, B., Delobel, P., Izopet, J., Cuzin, L. and Massip, P. (2012), Factors associated with a strictly undetectable viral load in HIV-1-infected patients. HIV Medicine, 13: 568–573. doi: 10.1111/j.1468-1293.2012.01012.x
- Issue published online: 11 SEP 2012
- Article first published online: 21 MAR 2012
- Manuscript Accepted: 16 FEB 2012
- antiretroviral therapy;
- HIV-1 RNA;
- low-level viraemia;
- residual viraemia;
- viral reservoirs
The aim of the study was to identify factors associated with a strictly undetectable viral load (VL) using a routine sensitive real-time polymerase chain reaction (RT-PCR) technology.
From a large prospective cohort, 1392 patients with a VL < 50 HIV-1 RNA copies/mL while receiving a three-drug suppressive regimen for at least 1 year were included in a cross-sectional analysis. Patients were classified into three groups and compared by univariate and multivariate analysis: 479 patients with a strictly undetectable VL (group 1; 34%), 617 patients with detectable VL below the threshold of 20 copies/mL (group 2; 44%), and 296 patients with a VL of 20–50 copies/mL (group 3; 12%).
Comparing groups 1 and 2, VL zenith < 5 log10 copies/mL [odds ratio (OR) 1.51; 95% confidence interval (CI) 1.15–1.99; P = 0.003], current CD4 T-cell count < 500 cells/μL (OR 1.44; 95% CI 1.08–1.92; P = 0.01), and duration of viral suppression < 50 copies/mL longer than 2 years (OR 2.32; 95% CI 1.20–4.54; P = 0.01) were associated with undetectable VL. Comparing groups 1 and 3, VL zenith < 5 log10 copies/mL (OR 2.48; 95% CI 1.75–3.50; P < 0.001), duration of viral suppression < 50 copies/mL longer than 1 year (OR 3.33; 95% CI 1.66–6.66; P = 0.0006), and nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens (OR 1.45; 95% CI 1.03–2.04; P = 0.03) were associated with undetectable VL. No individual drug effect was found within NNRTI molecules.
Longer duration of viral suppression < 50 copies/mL, lower viral load zenith and NNRTI-based regimen were independently associated with a strictly undetectable viral load. This routinely used RT-PCR assay may prove to be a valuable tool in further large-scale studies.