Cuzin Lise, Flandre Philippe, Allavena Clotilde, Palich Romain, Duvivier Claudine, Becker Agathe, Laroche Hélène, Pugliese Pascal, Cabie André
Infectious and Tropical Diseases Unit, Martinique University Hospital, Fort de France, Martinique, French West Indies.
CERPOP, Toulouse Paul Sabatier University, INSERM UMR1295, Toulouse, France.
J Antimicrob Chemother. 2023 Apr 3;78(4):1111-1116. doi: 10.1093/jac/dkad056.
To analyse the occurrence of virological failure (VF) in patients starting ART with an integrase strand transfer inhibitor (INSTI)-based regimen in recent years, in relation with previous episodes of low-level viral load (LLVL).
Patients starting a first ART between 1 January 2015 and 31 December 2020 based on two NRTIs and one INSTI were included if after virological control (two measures of VL < 50 copies/mL) they had a minimum of two additional VL measurements. Cox models adjusted for sex, age, acquisition group, hepatitis B or C coinfection, place of birth, year of ART initiation, CD4+ T cells and VL at ART initiation, duration of known HIV infection and of ART regimen were used to assess the association between the time to VF and the occurrence of LLVL. ART regimen was evaluated as time-varying covariate.
LLVL was described in 13.7% and VF in 11% of the 3302 patients. LLVL was associated with VF [adjusted HR (aHR) 1.76, 95% CI 1.28-2.41], as well as age (aHR 0.97/year, 95% CI 0.96-0.98), CD4+ T cell count at ART initiation (aHR 0.93, 95% CI 0.87-0.98), heterosexual transmission (aHR 1.76, 95% CI 1.30-2.37) and being born abroad (aHR 1.50, 95% CI 1.17-1.93).
LLVL was related to VF. Even in the absence of subsequent failure, LLV episodes have a cost. Thus any VL value above 50 copies/mL should lead to enhanced adherence counselling.
分析近年来开始接受基于整合酶链转移抑制剂（INSTI）方案抗逆转录病毒治疗（ART）的患者中病毒学失败（VF）的发生情况，并与既往低水平病毒载量（LLVL）发作相关联。
纳入2015年1月1日至2020年12月31日期间开始首次ART治疗、基于两种核苷类逆转录酶抑制剂（NRTIs）和一种INSTI的患者，条件是在病毒学控制（两次病毒载量测量值＜50拷贝/mL）后至少进行另外两次病毒载量测量。使用经性别、年龄、感染途径分组、合并乙型或丙型肝炎感染、出生地、开始ART的年份、开始ART时的CD4 + T细胞和病毒载量、已知HIV感染持续时间以及ART方案持续时间校正的Cox模型，评估VF发生时间与LLVL发生之间的关联。将ART方案作为随时间变化的协变量进行评估。
3302例患者中，13.7%出现LLVL，11%出现VF。LLVL与VF相关[校正后风险比（aHR）为1.76，95%置信区间（CI）为1.28 - 2.41]，同时还与年龄（aHR为0.97/岁，95%CI为0.96 - 0.98）、开始ART时的CD4 + T细胞计数（aHR为0.93，95%CI为0.87 - 0.98）、异性传播（aHR为1.76，95%CI为1.30 - 2.37）以及出生在国外（aHR为1.50，95%CI为1.17 - 1.93）相关。
LLVL与VF相关。即使随后没有出现失败情况，LLVL发作也有代价。因此，任何高于50拷贝/mL的病毒载量值都应导致加强依从性咨询。
