Durability of viral suppression with first-line antiretroviral therapy in patients with HIV in the UK: an observational cohort study

Jemma O'Connor, Colette Smith, Fiona C. Lampe, Margaret A. Johnson, David R. Chadwick, Mark Nelson, David Dunn, Alan Winston, Frank A. Post, Caroline Sabin, Andrew N. Phillips*, Jonathan Ainsworth, Sris Allan, Jane Anderson, Abdel Babiker, David Chadwick, Valerie Delpech, David Dunn, Martin Fisher, Brian GazzardRichard Gilson, Mark Gompels, Phillip Hay, Teresa Hill, Margaret Johnson, Sophie Jose, Stephen Kegg, Clifford Leen, Fabiola Martin, Mark Nelson, Chloe Orkin, Adrian Palfreeman, Andrew Phillips, Deenan Pillay, Frank Post, Jillian Pritchard, Caroline Sabin, Memory Sachikonye, Achim Schwenk, Anjum Tariq, Roy Trevelion, John Walsh, A. Glabay, N. Perry, S. Tilbury, E. Youssef, D. Churchill, B. Gazzard, M. Nelson, R. Everett, D. Asboe, S. Mandalia, F. Post, H. Korat, C. Taylor, Z. Gleisner, F. Ibrahim, L. Campbell, R. Gilson, N. Brima, I. Williams, M. Johnson, M. Youle, F. Lampe, C. Smith, R. Tsintas, C. Chaloner, S. Hutchinson, C. Sabin, A. Phillips, T. Hill, S. Jose, A. Thornton, S. Huntington, J. Walsh, N. Mackie, A. Winston, J. Weber, F. Ramzan, M. Carder, C. Orkin, J. Lynch, J. Hand, C. de Souza, S. Munshi, J. Ainsworth, A. Schwenk, S. Miller, C. Wood, C. Leen, A. Wilson, S. Morris, M. Gompels, S. Allan, A. Palfreeman, K. Memon, A. Lewszuk, D. Chadwick, E. Cope, J. Gibson, S. Kegg, P. Main, S. Mitchell, M. Hunter, M. Dhillon, F. Martin, S. Russell-Sharpe, S. Allan, A. Harte, S. Clay, A. Tariq, H. Spencer, R. Jones, J. Pritchard, S. Cumming, C. Atkinson

*Corresponding author for this work

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Abstract

Background The length of time that people with HIV on antiretroviral therapy (ART) with viral load suppression will be able to continue before developing viral rebound is unknown. We aimed to investigate the rate of first viral rebound in people that have achieved initial suppression with ART, to determine factors associated with viral rebound, and to use these estimates to predict long-term durability of viral suppression. Methods The UK Collaborative HIV Cohort (UK CHIC) Study is an ongoing multicentre cohort study that brings together in a standardised format data on people with HIV attending clinics around the UK. We included participants who started ART with three or more drugs and who had achieved viral suppression (≤50 copies per mL) by 9 months after the start of ART (baseline). Viral rebound was defined as the first single viral load of more than 200 copies per mL or treatment interruption (for ≥1 month). We investigated factors associated with viral rebound with Poisson regression. These results were used to calculate the rate of viral rebound according to several key factors, including age, calendar year at start of ART, and time since baseline. Results Of the 16 101 people included, 4519 had a first viral rebound over 58 038 person-years (7·8 per 100 person-years, 95% CI 7·6–8·0). Of the 4519 viral rebounds, 3105 (69%) were defined by measurement of a single viral load of more than 200 copies per mL, and 1414 (31%) by a documented treatment interruption. The rate of first viral rebound declined substantially over time until 7 years from baseline. The other factors associated with viral rebound were current age at follow-up and calendar year at ART initiation (p<0·0001) and HIV risk group (p<0·0001); higher pre-ART CD4 count (p=0·0008) and pre-ART viral load (p=0·0003) were associated with viral rebound in the multivariate analysis only. For 1322 (29%) of the 3105 people with observed viral rebound, the next viral load value after rebound was 50 copies per mL or less with no regimen change. For HIV-positive men who have sex with men, our estimates suggest that the probability of first viral rebound reaches a plateau of 1·4% per year after 45 years of age, and 1·0% when accounting for the fact that 29% of viral rebounds are temporary elevations. Interpretation A substantial proportion of people on ART will not have viral rebound over their lifetime, which has implications for people with HIV and the planning of future drug development. Funding UK Medical Research Council.

Original languageEnglish
Pages (from-to)e295-e302
JournalThe Lancet HIV
Volume4
Issue number7
DOIs
Publication statusPublished - Jul 2017

Bibliographical note

Publisher Copyright:
© 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.

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