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.
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。