Are previous treatment interruptions associated with higher viral rebound rates in patients with viral suppression?

NMUH Staff Publications

22

<div style="line-height: 17.999801635742188px;"><h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;"><span style="font-size: 10pt;">OBJECTIVE:</span></h4><p style="margin: 0px 0px 0.5em;"><span style="font-size: 8pt;"><span style="font-size: 10pt;">We investigated whether <span class="highlight">previous</span> <span class="highlight">treatment</span> <span class="highlight">interruptions</span> are <span class="highlight">associated</span> with a raised risk of <span class="highlight">viral</span> <span class="highlight">rebound</span> in individuals who have attained virological suppression.</span></span></p><h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;"><span style="font-size: 10pt;">METHODS:</span></h4><p style="margin: 0px 0px 0.5em;"><span style="font-size: 10pt;">All <span class="highlight">patients</span> achieving an undetectable <span class="highlight">viral</span> load while on <span class="highlight">therapy</span> were followed until <span class="highlight">viral</span> <span class="highlight">rebound</span> or the time of the last <span class="highlight">viral</span> load. Poisson regression was used to describe the independent impact of <span class="highlight">treatment</span> <span class="highlight">interruptions</span> on <span class="highlight">rebound</span> <span class="highlight">rates</span>.</span></p><h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;"><span style="font-size: 10pt;">RESULTS:</span></h4><p style="margin: 0px 0px 0.5em;"><span style="font-size: 10pt;">A total of 12,977 <span class="highlight">patients</span> from the United Kingdom Collaborative HIV Cohort (UK CHIC) Study achieved a <span class="highlight">viral</span> load of less than 50 copies/ml. These <span class="highlight">patients</span> contributed a total of 37,314 person-years of follow-up. The overall <span class="highlight">rebound</span> rate was 8.07 (7.78, 8.36) per 100 person-years. In adjusted analyses, <span class="highlight">rates</span> of <span class="highlight">viral</span> <span class="highlight">rebound</span> were up to 64% <span class="highlight">higher</span> (rate ratio 1.64; 1.43, 1.88) in those who had previously interrupted <span class="highlight">therapy</span> compared with those who had not. <span class="highlight">Patients</span> who had interrupted at detectable <span class="highlight">viral</span> loads had up to a 74% (1.74; 1.42, 2.14) <span class="highlight">higher</span> chance of rebounding compared with those who had not interrupted with a detectable <span class="highlight">viral</span> load. We found no evidence to suggest interrupting <span class="highlight">treatment</span> at an undetectable <span class="highlight">viral</span> load was <span class="highlight">associated</span> with <span class="highlight">viral</span> <span class="highlight">rebound</span>.</span></p><h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;"><span style="font-size: 10pt;">CONCLUSION:</span></h4><p style="margin: 0px 0px 0.5em;"><span style="font-size: 8pt;"><span style="font-size: 10pt;">Among <span class="highlight">patients</span> with an undetectable <span class="highlight">viral</span> load, having previously interrupted <span class="highlight">therapy</span> while the <span class="highlight">viral</span> load was detectable is <span class="highlight">associated</span> with a raised risk of <span class="highlight">rebound</span>.</span></span></p></div>