TY - JOUR

T1 - Impact of pre-antiretroviral treatment HIV-RNA on time to successful virological suppression and subsequent virological failure - two nationwide, population-based cohort studies

AU - Sörstedt, Erik

AU - Tetens, Malte Mose

AU - Nilsson, Staffan

AU - Nowak, Piotr

AU - Treutiger, Carl Johan

AU - Månsson, Fredrik

AU - Änghagen, Lena

AU - Gisslén, Magnus

AU - Obel, Niels

AU - Yilmaz, Aylin

N1 - Funding Information: Funding: Our research was supported by an agreement between the Swedish government and county councils, the ALF-agreement (ALFGBG-70150) and (ALFGBG-717531), and by the Gothenburg Medical Society [18/780621]. The Danish HIV study was supported by Preben og Anne Simonsens Fond. The study sponsors had no influence on the study design, data collection, data analysis, interpretation of data, or the writing process. Publisher Copyright: © 2022 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2023

Y1 - 2023

N2 - Background: The impact of pre-antiretroviral treatment (ART) HIV-RNA on time to successful virological suppression and subsequent failure in HIV patients remains poorly investigated. Methods: We used the Swedish InfCareHIV database and the Danish HIV Cohort Study to evaluate impact of pre-ART HIV-RNA on primary virological suppression (HIV-RNA < 50copies/ml) and risk of secondary virological failure (two consecutive HIV-RNA > 200copies/ml or one >1000copies/ml). The study included 3366 Swedish and 2050 Danish ART naïve individuals who initiated ART in the period 2000-2018. We used Kaplan-Meier estimates and Cox regression analyses to estimate absolute risks and hazard ratios. Results: In both cohorts, more than 95% of patients with a pre-ART HIV-RNA <100 000copies/ml obtained virological suppression within the first year after ART initiation contrasting 74% (Sweden) and 86% (Denmark) in those with HIV-RNA >1 000 000copies/ml. Almost all patients obtained virological suppression after four years irrespective of pre-ART HIV-RNA. In contrast, we observed no substantial impact of pre-ART HIV-RNA on risk of virological failure once virological suppression was obtained. Conclusion: High pre-ART HIV-RNA is strongly associated with increased time to successful virological suppression, but pre-ART HIV-RNA has no impact on risk of subsequent virological failure.

AB - Background: The impact of pre-antiretroviral treatment (ART) HIV-RNA on time to successful virological suppression and subsequent failure in HIV patients remains poorly investigated. Methods: We used the Swedish InfCareHIV database and the Danish HIV Cohort Study to evaluate impact of pre-ART HIV-RNA on primary virological suppression (HIV-RNA < 50copies/ml) and risk of secondary virological failure (two consecutive HIV-RNA > 200copies/ml or one >1000copies/ml). The study included 3366 Swedish and 2050 Danish ART naïve individuals who initiated ART in the period 2000-2018. We used Kaplan-Meier estimates and Cox regression analyses to estimate absolute risks and hazard ratios. Results: In both cohorts, more than 95% of patients with a pre-ART HIV-RNA <100 000copies/ml obtained virological suppression within the first year after ART initiation contrasting 74% (Sweden) and 86% (Denmark) in those with HIV-RNA >1 000 000copies/ml. Almost all patients obtained virological suppression after four years irrespective of pre-ART HIV-RNA. In contrast, we observed no substantial impact of pre-ART HIV-RNA on risk of virological failure once virological suppression was obtained. Conclusion: High pre-ART HIV-RNA is strongly associated with increased time to successful virological suppression, but pre-ART HIV-RNA has no impact on risk of subsequent virological failure.

KW - antiretroviral therapy

KW - CD4nadir

KW - HIV-RNA

KW - pre-antiretroviral therapy HIV-RNA

U2 - 10.1097/QAD.0000000000003425

DO - 10.1097/QAD.0000000000003425

M3 - Journal article

C2 - 36541640

AN - SCOPUS:85144253558

VL - 37

SP - 279

EP - 286

JO - AIDS

JF - AIDS

SN - 1350-2840

IS - 2

ER -