AIDS 2014: Low Level Viral Load Does Not Raise Risk of HIV Treatment Failure

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People with HIV who have a low-level viral load between 20 and 50 copies/mL were not more likely to experience virological failure of antiretroviral therapy (ART) compared with those who consistently maintained viral suppression below 20 copies/mL, according to research presented at the 20th International AIDS Conference in Melbourne.

Modern combination antiretroviral regimens can usually produce good viral suppression in most people with HIV. It is well known that viral suppression is associated with CD4 T-cell recovery and reduced HIV disease progression, but the effects of very low levels of HIV RNA are not fully understood, as widely used viral load tests have had a level of detection of 400, 200, and then 50 copies/mL. Current tests can measure down to 20 copies/mL, however, while highly sensitive research assays can detect as little as a single copy.

Ramon Teira and fellow investigators with the Spanish VACH Study Group investigated the implications of very low-level HIV viremia between 20-50 copies/mL. They looked at whether very low viral load was associated with a greater risk of virological failure (defined as 2 consecutive viral loads above 200 copies/mL or 1 such measurement followed by a treatment change) compared with either low-level viral load in the 50-200 copies/mL range or maintaining full suppression below 20 copies/mL.

This analysis included more than 21,000 HIV positive participants in the VACH cohort. More than three-quarters were men and the mean age at diagnosis was 30 years. .

The researchers selected patients who started ART after January 1997 and achieved viral suppression with 2 consecutive viral load measurements below 50 copies/mL, followed by full suppression indicated by at least 1 measurement below 20 copies/mL.

Results

"In the population of HIV-infected patients on ART who achieve full viral suppression below 20 copies/mL, those who experience subsequent episodes of very low levels of viremia(between 20 and 50 copies/mL), the risk of virological failure...is not higher than that of patients who remain fully suppressed," the researchers concluded.

9/4/14

Reference

R Teira, P Muñoz-Sanchez, I Suarez-Lozano, et al. Effect of viral suppression below 20 copies of HIV-RNA per millilitre of plasma on virological outcome of treated HIV-infected patients. 20th International AIDS Conference. Melbourne, July 20-25 2014. Abstract TUAB0101.