Low Viral Load of HIV Raises Risk of Disease Progression to AIDS and Most Risk of Comorbidities?
HIV-positive people with low viral loads, but detectable in the range of 50 to 500 or even 1000 copies / ml, may continue to have a high risk of AIDS-related events, but their chances of suffering from serious non-AIDS events, including heart, liver and kidney disease do not appear to increase, according to two Italian studies presented at the XV European AIDS Conference in Barcelona.
It is well known that effective combination antiretroviral therapy (ART / Cocktail), which suppresses HIV replication, dramatically reduces disease progression and improves the lives of people with HIV.Recent discoveries of large study Startshowed that people who start treatment soon after diagnosis had a lower risk of developing AIDS-related illnesses and events not related to AIDS, as well as the occurrence of death compared to those who waited until their célulasT CD4 counts fall to the old "standard level" of 350 CD4 T cells per milliliter of blood.
A small proportion of people with HIV has shown viral load low, but detectable, persistent despite treatment and the effects of low-level viremia are not fully understood. Even a low current level of viral replication can lead to increased immune activation and inflammation, which may contribute to the comorbidities unrelated to AIDS, such as heart disease, cancer and clots which can cause stroke and pulmonary embolism. However, observational studies major, had not previously observed association between low viremia and increased AIDS risk and disease unrelated to AIDS or death.
Andrea Antinori and fellow researchers, with the ICONA Foundation, conducted a cohort study that showed an estimated 3 months incidence of AIDS-related events, serious events not related to AIDS or the occurrence of deaths among people with low levels of viremia compared with those viral loads below 50 copies / ml (undetectable).
The analysis included 7277 participants ICONA Italian cohort who had at least 1 person / year follow-up with a viral load in 0 strip of 1000 copies / ml, at least 6 months after the beginning of a combination antiretroviral first line. Three-quarters were men, mostly white, middle-aged 37 years 18% were co-infected with hepatitis C. The average CD4 count at the start of ART was approximately 300 cells / mm3and 13% had been diagnosed with AIDS. The most common scheme Antiretroviral Therapy was that combines Sustiva (Efavirenz) Tenofovir / Emtricitabine (Truvada also used in PrEP), but a variety of other drugs was also used.
Participants were classified into researchers 4 groups, according to the viral load count six months after the initiation of ART:
- 0-50 copies / ml (n = 3919);
- 51-200 copies / ml (n = 1811);
- 201-500 copies / ml (n = 1117);
- 500-1000 copies / ml (n = 430).
They compared two results of effectiveness of treatment of viral load groups: AIDS or death from any cause, and non-AIDS events serious according to the definition.
- 204 events related to AIDS or death occurred during 28,429 persons / year of follow-up.
- event incidence rates related to AIDS or death were 0,52, 1,25, 1,91 and 1,06 by 100 people / year for participants with viral loads of 0-50, 51-200, 201-500 and 500-1000 copies / ml respectively.
- The adjusted risk of AIDS or death-related events was 1,74 (74%), 2,30 (more than double the risk, 130%) and 1,30 (up 30%) for people with 51-200, 201-500, and 500-1000 copies / ml respectively, compared with those 0-50 copies / ml. These differences were statistically significant for the 51-200 and 201-500 groups, but not for the group of 500-1000.
- 438 serious events not related to AIDS or deaths occurred during follow-up.
- Incidence rates of serious events not related to AIDS or death were 1,46, 1,77, 1,69 and 2,56 for their viral load groups.
- The adjusted risk of serious events not related to AIDS or death was 1,09 (little change - 9%), 1,00 (difference), and 1,54 (up 54%) for people with 51-200, 201-500 and 500 -1000 copies / ml, respectively, none of which were statistically significant.
"The low viral load, in the range of 51 the 500 copies / ml cubic blood was associated with an independent risk of developing a new diagnosis of AIDS which was to 2,3 times higher than that observed in viral load presence deleted "the researchers concluded.
"On the other hand, the low level of viremia appeared to predict a higher risk of serious occurrences unrelated to AIDS". [Translator's note: I kept this phrase in bold literally the same as the original, although I am not a scientist, it seemed to me more like a "guess" than a scientific conclusion. The original is as follows:"Conversely, low-level viremia did seem to predict a more elevated risk of serious non-AIDS events."
It was noted in this study, however, the classification into categories of viral load was based on current levels of viral load and could not be taken into account for prolonged periods of low level viral replication. "Blipes" occasional virus are not uncommon during the treatment, but persistent viremia is a major concern. They also said that the short period of follow-up, 3 months, may have underestimated the effects of long-term condition with respect to possible clinical outcomes.
These results, added to, "may be useful in the analysis of planning aimed at a better definition of treatment failure thresholds valid for clinical purposes and possibly increase the detailed treatment strategies and personally, case by case."
In the second study, Silvia Costarelli Hospital San Gerardo in Monza, and colleagues with the Italian MASTER cohort study analyzed the association between low-level persistent viremia (HIV RNA between 50 and 400 copies / ml) and increased risk of events related to diseases cardiovascular.
This analysis included 4393 people who achieved viral load below 50 copies / ml (NT - undetectable - in Brazil viral load tests are sensitive to an even lower level in 40 RNA copies per cubic blood milliliter) within 6 months after initiation of antiretroviral therapy, at least. About 70% were men, the majority were Italians and the average age of the research subjects at the beginning of was approximately 40 years. They had relatively advanced HIV disease, with a median CD4 count down 300 cells / mm3. The underlying cardiovascular risk was generally low, with only about 1%, and previous cardiovascular events.
A majority of patients 3576 and maintained complete viral suppression, however, experienced treatment failure 574 with viral rebound> 400 copies / ml and 243 had a low-level persistent viremia in two consecutive tests.
Observation of Soropositivo.Org Editor: In what follows below is an account of 93 deaths of people with viral suppression in progress. However, there is no report of CD4 T cell count of each of these patients and not even allude to the average counts of T cells CD4. I make this observation because I follow through Whats App application, giving moral support (a friendly conversation, an exchange of information, and considered, at least with respect to this site and the people who visit this site in search of knowledge and hope a lack of humanity in not mentioning this fact, it is not impossible that some of these patients were with a CD4 count which were to provide the occurrence of an opportunistic disease that, in this context, would have been the real cause of loss a human life, can psychologically torment the people who come into contact with this text are exactly this gradually and gradually viral suppression process.
During follow-up there was 45 cardiovascular events, 57 AIDS-related events and 93 deaths among people with viral suppression in progress: 18, 53 and 37, respectively, among people with viral rebound and 6, 5 and 4 among people with low levels of persistent viremia.
The researchers considered two outcomes compounds: first cardiovascular event, with related to AIDS or death event and first cardiovascular event or death, ignoring AIDS.
For the first outcome of the adjustments incidences were 11,7, 21,6 and 9,3 1000 per person / year, respectively; for people with complete viral suppression, viral rebound, and low-level persistent viremia. For the second outcome incidence rates were 8,6, 11,6 and 9,0, respectively. That is, the risk of adverse events was about 2 times higher for people with viral rebound, when AIDS was considered, but not when considered only cardiovascular events or deaths.
In a multivariate analysis, patients with viral rebound had a significantly higher risk for the first and second point of the composition in relation to people with ongoing viral suppression (hazard ratio 2,15 and 1,5, respectively). However, the persistence of low-level viremia was not associated with significantly different risk rates.
"Our results suggest that low-level persistent viremia does not influence cardiovascular disease," the researchers concluded. "Moreover, in our environment, the persistence of low-level viremia was not yet able to influence significantly the establishment of an AIDS framework or death.
In summary, the incidence of cardiovascular events, AIDS and death were similar to those with a continuous viral suppression and those with persistent low level viremia MASTER study, suggesting that the low level viral load does not increase the risk of events related or not AIDS. This conflicts with the results of ICONA, we did see a higher risk of AIDS among people with low viral load, but detectable.
Written by Liz Highleyman
Translated by Claudio SouzaOriginal in EnglishDoes Low-level HIV Viral Load Raise the Risk of Disease Progression and Comorbidities?
reviewed by Bob Volpe (Tantus Nominum pair nullum Elogium)
A Antinori, A Cozzi Lepri, Ammassari, et al. Low level of viremia (LLV) ranging from the 50 500 copies / mL associated with an increased risk of AIDS events in Icona Foundation cohort. XV European AIDS Conference. Barcelona, 21-24 October 2015. Summary PS4 / 2.
Costarelli S, D Bernasconi, Lapadula G, et al. The persistence of low level viremia of HIV and cardiovascular risk. XV European AIDS Conference. Barcelona, 21-24 October 2015. Resumo12 / 10 PE.