PDF(Pubmed)
Abstract：
There are conflicting data regarding baseline determinants of virological nonsuppression outcomes in persons with human immunodeficiency virus (HIV) starting antiretroviral treatment (ART). We evaluated the impact of different baseline variables in the RESPOND cohort.
We included treatment-naive participants aged ≥18 who initiated 3-drug ART, in 2014-2020. We assessed the odds of virological suppression (VS) at weeks 48 and 96 using logistic regression. Viral blips, low-level viremia (LLV), residual viremia (RV), and virological failure (VF) rates were assessed using Cox regression.
Of 4310 eligible participants, 72% started integrase strand transfer inhibitor (INSTI)-based regimens. At 48 and 96 weeks, 91.0% and 93.3% achieved VS, respectively. At 48 weeks, Kaplan-Meier estimates of rates were 9.6% for viral blips, 2.1% for LLV, 22.2% for RV, and 2.1% for VF. Baseline HIV-1 RNA levels >100 000 copies/mL and CD4+ T-cell counts ≤200/µL were negatively associated with VS at weeks 48 (adjusted odds ratio, 0.51 [95% confidence interval, .39-.68] and .40 [.27-.58], respectively) and 96 and with significantly higher rates of blips, LLV, and RV. CD4+ T-cell counts ≤200/µL were associated with higher risk of VF (adjusted hazard ratio, 3.12 [95% confidence interval, 2.02-4.83]). Results were consistent in those starting INSTIs versus other regimens and those starting dolutegravir versus other INSTIs.
Initial high HIV-1 RNA and low CD4+ T-cell counts are associated with lower rates of VS at 48 and 96 weeks and higher rates of viral blips, LLV, and RV. Low baseline CD4+ T-cell counts are associated with higher VF rates. These associations remain with INSTI-based and specifically with dolutegravir-based regimens. These findings suggest that the impact of these baseline determinants is independent of the ART regimen initiated.
We included treatment-naive participants aged ≥18 who initiated 3-drug ART, in 2014-2020. We assessed the odds of virological suppression (VS) at weeks 48 and 96 using logistic regression. Viral blips, low-level viremia (LLV), residual viremia (RV), and virological failure (VF) rates were assessed using Cox regression.
Of 4310 eligible participants, 72% started integrase strand transfer inhibitor (INSTI)-based regimens. At 48 and 96 weeks, 91.0% and 93.3% achieved VS, respectively. At 48 weeks, Kaplan-Meier estimates of rates were 9.6% for viral blips, 2.1% for LLV, 22.2% for RV, and 2.1% for VF. Baseline HIV-1 RNA levels >100 000 copies/mL and CD4+ T-cell counts ≤200/µL were negatively associated with VS at weeks 48 (adjusted odds ratio, 0.51 [95% confidence interval, .39-.68] and .40 [.27-.58], respectively) and 96 and with significantly higher rates of blips, LLV, and RV. CD4+ T-cell counts ≤200/µL were associated with higher risk of VF (adjusted hazard ratio, 3.12 [95% confidence interval, 2.02-4.83]). Results were consistent in those starting INSTIs versus other regimens and those starting dolutegravir versus other INSTIs.
Initial high HIV-1 RNA and low CD4+ T-cell counts are associated with lower rates of VS at 48 and 96 weeks and higher rates of viral blips, LLV, and RV. Low baseline CD4+ T-cell counts are associated with higher VF rates. These associations remain with INSTI-based and specifically with dolutegravir-based regimens. These findings suggest that the impact of these baseline determinants is independent of the ART regimen initiated.
摘要：
背景：关于开始抗逆转录病毒治疗（ART）的HIV感染者的病毒学非抑制结果的基线决定因素存在矛盾的数据。我们评估了不同基线变量对RESPOND队列的影响。
方法：我们纳入了年龄≥18岁的未治疗参与者，他们开始了3-药物ART，2014-2020年。我们使用逻辑回归评估了48周和96周的病毒学抑制（VS）的几率。病毒斑点，低水平病毒血症（LLV），使用Cox回归分析评估残留病毒血症(RV)和病毒学衰竭(VF)率.
结果：在4,310名符合条件的参与者中，72%起始整合酶链转移抑制剂(INSTI)为基础的方案。在48周和96周，91·0%和93·3%实现了VS，分别。48周时,Kaplan-Meier估计病毒突发性为9.6%，LLV2·1%，RV22·2%和VF2·1%。基线HIV-1RNA>100,000拷贝/mL和CD4计数≤200细胞/µL与VS在48周时呈负相关（aOR0·51;95CI：0·39-0·68和0·40;95CI：0·27-0·58）和96，并且具有明显更高的斑点率，LLV和RV。CD4+计数≤200个细胞/μL与较高的VF风险相关(aHR3·12;95CI:2·02-4·83)。结果是一致的，在那些开始INSTIs与其他方案和那些开始dolutegravir与其他INSTIs。
结论：最初的高HIV-1RNA和低CD4+计数与48周和96周时较低的VS发生率和较高的病毒斑点发生率相关，LLV和RV。低基线CD4+计数与较高的VF率相关。这些关联与INSTI和特别是基于dolutegravir的方案仍然存在。这些发现表明，这些基线决定因素的影响与ART方案的启动无关。
方法：我们纳入了年龄≥18岁的未治疗参与者，他们开始了3-药物ART，2014-2020年。我们使用逻辑回归评估了48周和96周的病毒学抑制（VS）的几率。病毒斑点，低水平病毒血症（LLV），使用Cox回归分析评估残留病毒血症(RV)和病毒学衰竭(VF)率.
结果：在4,310名符合条件的参与者中，72%起始整合酶链转移抑制剂(INSTI)为基础的方案。在48周和96周，91·0%和93·3%实现了VS，分别。48周时,Kaplan-Meier估计病毒突发性为9.6%，LLV2·1%，RV22·2%和VF2·1%。基线HIV-1RNA>100,000拷贝/mL和CD4计数≤200细胞/µL与VS在48周时呈负相关（aOR0·51;95CI：0·39-0·68和0·40;95CI：0·27-0·58）和96，并且具有明显更高的斑点率，LLV和RV。CD4+计数≤200个细胞/μL与较高的VF风险相关(aHR3·12;95CI:2·02-4·83)。结果是一致的，在那些开始INSTIs与其他方案和那些开始dolutegravir与其他INSTIs。
结论：最初的高HIV-1RNA和低CD4+计数与48周和96周时较低的VS发生率和较高的病毒斑点发生率相关，LLV和RV。低基线CD4+计数与较高的VF率相关。这些关联与INSTI和特别是基于dolutegravir的方案仍然存在。这些发现表明，这些基线决定因素的影响与ART方案的启动无关。
