The Occurrence of HIV ‘Blips’ May Predict the Incidence of SNADEs

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.