Factors Associated with 10 Years of Continuous HIV Viral Load Suppression on HAART
The principal goal of HAART is sustained viral load (VL) suppression resulting in immune reconstitution and a reduction in the risk of AIDS and death. We studied the factors associated with 10 years of continuous VL suppression on HAART in the US Military HIV Natural History Study.
We evaluated 5721 NHS participants, of which 276 (4.8%) met inclusion criteria. Participants with continuous VL suppression (CS, n=149) were compared to those who experienced ≥1 virologic failure (VF, n=127). All participants were required to have ≥1 VL determination each year for >10 years on HAART and no treatment interruptions >6 months. VL suppression (<400 c/mL) within 1 year was required for the CS group and maintained for >10 years on HAART. VF was defined as 2 consecutive VLs >400 c/mL after initial suppression. Factors associated with >10 years of VL suppression were evaluated by multivariate logistic regression.
Compared to the VF group, CS participants at HAART initiation (HI) had higher median CD4 counts (375 cells/uL, IQR 256-499 vs 261 cells/uL, IQR 146-400; P<0.001), lower VL (4.4 log10 c/mL, IQR 3.5-4.9 vs 4.5 log10 c/mL, IQR 3.8-5.0; P=0.048), and were less likely to start treatment in the early HAART era (66 vs 90%, for years 1996-1999; P<0.001). CS participants also had a lower proportion of antiretroviral (ARV) use prior to HAART (37 vs 83%; P<0.001), used fewer HAART regimens (3, IQR 2-5 vs 7, IQR 4-9; P<0.001), and had a lower proportion of new AIDS events by 10 years of HAART (5 vs 13%; P=0.032). The factors associated with 10-year VL suppression by multivariate logistic regression included log10VL at HI (OR 0.60, 95% CI 0.39, 0.89; P=0.013), ARV use prior to HI (OR 0.14, 95% CI 0.06, 0.31; P<0.001), and number of HAART regimens used (OR 0.72, 95% CI 0.62, 0.82; P<0.001). Demographic characteristics, prior AIDS, CD4 at HI, and self-reported adherence were not associated with 10-year VL suppression.
Sustained VL suppression is a key to long-term health in HIV-infected patients, as demonstrated by the lower proportion of AIDS events observed 10 years after HI. The current use of more potent and well-tolerated regimens may mitigate the negative factors of pre-HAART VL and prior ARV use encountered by treatment initiated in the early HAART era.
T. O'bryan, None
T. Lalani, None
A. Ganesan, None
B. Agan, None
J. Okulicz, None
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