1546. Predictors of Rebound Viremia in Treatment Experienced Patients with Undetectable Viral Load
Session: Poster Abstract Session: HIV: Treatment Failure
Friday, October 28, 2016
Room: Poster Hall
Posters
  • KB_poster.pdf (2.0 MB)
  • Background:

    With the advent of combination antiretroviral therapy, durable suppression of plasma HIV RNA (VL) is achievable in the majority of HIV- infected patients. Yet, a significant number experience viral rebound (VR). This study aims to determine factors associated with VR in patients at our urban HIV clinic.  

    Methods:

    Our retrospective cohort study identified treatment experienced patients, with undetectable HIV VL, who attended the HIV clinic between 01/2013 and 06/2015. We excluded patients with fewer than 2 VL measurements during the study period. VR was defined as 1 HIV VL ≥ 200 copies/mL or 2 consecutive VL ≥ 50 copies/mL. Sociodemographic, clinical and treatment factors were analyzed with respect to the occurrence of VR.  

    Results:  

    Of 828 treatment-experienced patients with undetectable VL, 183 (22%) experienced VR. On univariate analysis, younger age, African American race, hospitalized patients, Medicaid beneficiaries and substance abuse were associated with higher likelihood of VR (table 1). Patients with VR had significantly lower CD4 count and CD4/CD8 ratio. There was no association between gender, pill burden, educational level or income and likelihood of VR.  On multivariate analysis, African American race, hospitalization and lower CD4 counts were associated with a significantly higher odds of VR.

    Conclusion:

    Despite highly effective therapies, failure to maintain viral suppression continues to be a frequent occurrence, influenced by various sociodemographic and clinical factors. Contrary to previous studies, our study did not demonstrate an association between single tablet regimens and lower risk of VR.

    Analysis

    Univariate

    Multivariate

     

    Controls

    VR

    p-value

    Adjusted OR

    95% CI

    N

    645

    183

     

     

     

    Age*

    49.1

    45.5

    0.001

    1.35 α

    0.95 – 1.93

    Female Gender

    128 (20%)

    37 (20%)

    0.91

     

     

    African American

    387 (60%)

    133 (73%)

    0.007

    1.59

    1.09 – 2.33

    Hospitalized

    139 (22%)

    62 (34%)

    0.001

    1.56

    1.04 – 2.32

    Hepatitis C

    77 (12%)

    27 (15%)

    0.31

     

     

    Substance Abuse

    221 (34%)

    80 (44%)

    0.02

    1.26

    0.88 – 1.80

    Mood Disorder

    126 (20%)

    38 (21%)

    0.71

     

     

    CD4 count*

    501

    376

    0.001

    2.16 β

    1.34 – 3.49

    CD4/CD8*

    0.87

    0.65

    0.001

     

     

    Medicaid Beneficiary

    214 (33%)

    80 (44%)

    0.009

     

     

    Lower then State Median Income

    435 (71%)

    126 (72%)

    0.69

     

     

    Single Tablet Regimen

    312 (48%)

    97 (53%)

    0.27

     

     

    Once Daily Regimen

    463 (72%)

    144 (79%)

    0.06

     

     

    * mean

    α <50 vs. ≥ 50 years

    β <200 vs. ≥ 200 cells/mm3

    Kassem Bourgi, MD1,2, Indira Brar, MD3 and Norman Markowitz, MD3, (1)Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, (2)Internal Medicine, Henry Ford Hospital / Wayne State University, Detroit, MI, (3)Infectious Diseases, Henry Ford Hospital / Wayne State University, Detroit, MI

    Disclosures:

    K. Bourgi, None

    I. Brar, ViiV Healthcare: Investigator , Investigator payment clinical trial conduct (HIV)
    Gilead: Investigator and Speaker's Bureau , Investigator payment clinical trial conduct (HIV) and Speaker honorarium
    Janssen: Investigator and Speaker's Bureau , Investigator payment clinical trial conduct (HIV) and Speaker honorarium

    N. Markowitz, None

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