1085. Impact of Low-Level Viremia (LLV) on Virologic Outcomes in HIV-Positive Patients
Session: Poster Abstract Session: HIV: Resistance
Friday, October 9, 2015
Room: Poster Hall
Posters
  • LLV_IDWeek_BStevens.pdf (221.3 kB)
  • Background: Current guidelines for the treatment of HIV recommend targeting a HIV viral load (VL) below the level detected by commonly used assays.  The guidelines also define virologic failure as a sustained VL greater than 200 copies per milliliter (cpm).  The consequences for patients with a VL between 20 and 200 cpm are not well understood.  Few studies have examined the relationship between low-level viremia (LLV) and the presence of resistance mutations and virologic failure, but the consequences of this phenomenon remain uncertain.  

    Methods: A retrospective cohort study was completed comparing time to virologic failure in patients with LLV versus those with an undetectable VL while on antiretroviral therapy (ART) during the period of October 1, 2004 to September 30, 2014.  A Kaplan-Meier analysis of event-free survival was used to compare the primary outcome between the study groups. 

    Results: There were 217 patients enrolled in the LLV group and 142 patients enrolled in the undetectable VL group.  There were 138 patients in the LLV group and 42 patients in the undetectable VL group who progressed to virologic failure.  The time to virologic failure was significantly greater in the LLV group compared to the undetectable VL group (9.3 months vs. 59.1 months, p<0.001).  There was a significant increased risk of virologic failure in patients with previous documented virologic failure, patients receiving a boosted-protease inhibitor regimen, and patients receiving a regimen consisting of three NRTI medications. 

    Conclusion: Patients experiencing LLV are at an increased risk of virologic failure.  There should be a heightened awareness among providers when their patients are having persistent VLs in order to make an early intervention and improve patient outcomes.  Further investigation is needed to determine the effects of adherence on LLV as well as the most appropriate intervention.

    Brooke Stevens, PharmD, Pharmacy, Indiana University Health, Indianapolis, IN, Eric Farmer, PharmD, BCPS, Indiana University Health, Indianapolis, IN, Lisa Fletcher, PharmD, BCPS, WakeMed Hospital - Raleigh, Raleigh, NC and Melody Berg, PharmD, BCPS AQ-ID, Pharmacy, Indiana University, Indianapolis, IN

    Disclosures:

    B. Stevens, None

    E. Farmer, None

    L. Fletcher, None

    M. Berg, None

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