2161. The Occurrence of HIV ‘Blips’ May Predict the Incidence of SNADEs
Session: Poster Abstract Session: HIV Inflammation and Immune Activation
Saturday, October 29, 2016
Room: Poster Hall
Background: Serious non-AIDS clinical events (SNADEs) are an important cause of morbidity and mortality in persons with HIV. Transient elevations in HIV RNA (‘blips’) may represent a stimulus of chronic inflammation associated with the occurrence of SNADES.

Methods: Retrospective study of treatment-naïve individuals initiating antiretroviral therapy from 1996-2011. Blips were defined as an elevation less than 1000 copies/mL between undetectable viral load measurements. Clinical Events (CEs) were defined as SNADEs and/or an AIDS-defining OI (AIDSOI).

Results: There were 528 patients with a median age of 34.8 years; 64.8% were male. The median length of follow-up was 10.9 years (25-75 interquartile range= 6.9 – 14.6 years). The median baseline HIV RNA level (BLVL) was 66,500 copies/mL; median baseline CD4 count (BLCD4) was 230 cells/mL. 36.6% of the cohort had at least one blip with 12.3% experiencing multiple blips. After becoming undetectable, a CE was noted in 41.9% of patients with 34.9% having at least 1 SNADE and 11.4% had at least 1 AIDSOI. There was a trend toward more SNADES in persons with blips (39.9% vs. 31.9%, P=0.06). No significant differences were found in overall CE (46.1% vs. 39.4%, p=0.13), AIDSOI (12.6% vs. 9.3%, p=0.25) or BLCD4 (183 cells/mL vs. 239 cells/mL, p = 0.10) in patients with blips compared to those without blips. A higher median BLVL was seen in patients with blips (86,550 copies/ml vs. 55,918 copies/ml, p = 0.02). Fewer blips were seen in women (30.4% vs. 40.1%, p = 0.05).

Conclusion: Overall there was no difference in subsequent clinical events with or without blips. There was a non-significant trend towards more SNADES in persons with blips. A higher pre-ART HIV VL was associated with more blips. Blips may be associated with some but not all clinical events in persons with HIV.

Anas Jawaid, B.A., Walter Donica, B.S. and Carl Fichtenbaum, MD, FIDSA, Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH


A. Jawaid, None

W. Donica, None

C. Fichtenbaum, None

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