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- Title
Immune activation despite suppressive highly active antiretroviral therapy is associated with higher risk of viral blips in HIV-1-infected individuals.
- Authors
Zoufaly, A; Kiepe, JG; Hertling, S; Hüfner, A; Degen, O; Feldt, T; Schmiedel, S; Kurowski, M; Lunzen, J
- Abstract
Objectives Viral blips are thought to represent random biological variations around a steady state of residual HIV viraemia and to lack clinical significance. We aimed to assess the association of immune activation and the occurrence of blips. Methods HIV-infected patients from our out-patient cohort who developed a blip after having been on fully suppressive highly active antiretroviral therapy ( HAART) for at least 180 days were matched with patients without blips according to duration of complete viral suppression ( CVS), age, sex and Centers for Disease Control and Prevention ( CDC) stage. Frequencies of CD3+, CD3+ CD4+, CD3+ CD8+, CD3+ HLA- DR+, CD4+CD45RA+, CD16+CD56+CD3− and CD19+ cells, as well as C-reactive protein ( CRP) levels and clinical parameters, were included in conditional logistic regression models. Adherence to HAART was assessed by measuring prescribed nonnucleoside reverse transcriptase inhibitor ( NNRTI) or protease inhibitor ( PI) plasma levels in a sample of 57 patients. Results Eighty-two patients with viral blip were matched with 82 controls from the same cohort. The mean age was 47.2 years [standard deviation ( SD) 12.1 years], 80.5% of patients were male and 42.7% had CDC stage C disease. Viral blips occurred after a median of 14 months [interquartile range ( IQR) 8-34 months] of CVS. In the logistic regression, activated CD3+HLA-DR+ lymphocytes [odds ratio ( OR) 1.25 per 100 cells/μL; 95% confidence interval ( CI) 1.02-1.54; P = 0.03] were significantly associated with blips and there was a trend for an association of longer time on HAART with blips ( OR 1.31 per year; 95% CI 0.96-1.78; P = 0.09). No between-group difference regarding subtherapeutic drug levels was found ( P = 0.46). Conclusions The occurrence of viral blips after suppressive HAART was associated with elevated markers of T-cell activation. Blips may identify a subset of patients with higher immune activation and increased risk for HIV disease progression.
- Subjects
CONFIDENCE intervals; HIV-positive persons; PATIENT compliance; STATISTICAL hypothesis testing; STATISTICS; T cells; T-test (Statistics); DATA analysis; PROTEASE inhibitors; VIRAL load; HIGHLY active antiretroviral therapy; DATA analysis software; NON-nucleoside reverse transcriptase inhibitors; DESCRIPTIVE statistics; ODDS ratio
- Publication
HIV Medicine, 2014, Vol 15, Issue 8, p449
- ISSN
1464-2662
- Publication type
Article
- DOI
10.1111/hiv.12134