Incomplete HIV Suppression at 6 Months Linked to Substantially Increased Mortality Risk

Incomplete suppression of plasma human immunodeficiency virus (HIV) ribonucleic acid (RNA) 6 months after the initiation of antiretroviral therapy is associated with a significant 10-year risk of all-cause mortality in patients with HIV, according to a recent study.

It is not currently known whether there is a threshold of detectable HIV RNA under 1000 copies/ml after the initiation of antiretroviral therapy that is associated with the 10-year risk of all-cause mortality.
__________________________________________________________________________________________________________________

RELATED CONTENT
HIV Viral Rebound Can Occur in Pregnant Women on Combination ART
Single Measurement of Viral Load May be Ineffective for Estimating HIV Status
__________________________________________________________________________________________________________________

For their study, the researchers assessed nearly 8000 US patients who had initiated antiretroviral therapy between January 1, 1998, and December 21, 2013. Follow-up began 6 months after the initiation of therapy and lasted until death. Patient data was administratively censored after 10 years or on December 31, 2014.

Viral load was evaluated 6 months after the initiation of therapy. Nonparametric multiple imputation was used to account for left-censored viral load measurements. All-cause mortality hazard ratios were estimated via Cox proportional hazards models. Risk curves were constructed using Nelson-Aalen cumulative hazard estimates. Inverse probability of exposure weights was used to standardize estimated hazard ratios and risk curves to the total study population.

Ultimately, the researchers found that no demonstrable viral load threshold between 30 and 500 copies/ml was associated with a significant increase in 10-year mortality. Results indicated that the standardized 10-year risk of mortality among patients with viral loads between 400 and 999 copies/ml (20%) at 6 months following therapy initiation was similar to that of patients with viral loads between 1000 and 4 million copies/ml (23%).

“Incomplete suppression of plasma HIV RNA 6 months after starting therapy is associated with substantial 10-year all-cause mortality risk, highlighting the importance of rapid viral load suppression after therapy initiation,” the researchers concluded.

—Christina Vogt

Reference:

Lee JS, Cole SR, Richardson DB, et al. Incomplete viral suppression and mortality in HIV patients after antiretroviral therapy initiation. AIDS. 2017;31(14):1989-1997. doi:10.1097/QAD.0000000000001573.