Virus- Risk of HIV Treatment Failure Present Even in Those
With Low Viral Load
Risk of HIV Treatment Failure Present
Even in Those With Low Viral Load
Nov. 26, 2013 — People with human immunodeficiency virus
(HIV) run a higher risk of
virologic failure than previously thought, even when their number of RNA
copies of the retrovirus per millilitre of blood is slightly above the
detection threshold, according to a study by Claudie Laprise at the University
of Montreal's Department of Social and Preventative Medicine. Her findings were
published in Clinical Infectious Diseases.
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The study was conducted in close collaboration with doctors
from the Clinique médicale du Quartier Latin de Montréal, based on data from
the files of 1,860 people living with HIV and covering a period of 12 years.
Nearly 94% of the patients were men.
Minimizing the presence of the retrovirus The prognosis for
people with HIV has considerable improved since the advent of antiretroviral
therapy (ART) in 1996. ART acts by reducing the presence of the retrovirus in
the blood of infected people. This maintains the immune functions required to
prevent the disease from progressing to acquired immunodeficiency syndrome
(AIDS). From a clinical point of view, the viral load test measures the activity
of HIV in the patient and the effectiveness of ART. The goal of treatment is to
keep the viral load below
the detection limit, which is about 50 copies of viral RNA/ml.
Reducing the risk of virologic failure Despite treatment,
patients sometimes show persistent
low viral load during medical follow-up, from 50 to 1,000 copies/ml, for a number of months.
The higher the persistent viral loads, the higher the patients are at risk of
developing virologic failure. "Virologic failure, defined in this study as a viral load above 1,000 copies/ml of viral
RNA in the blood, is to be avoided, not least because it shows the
progression of the disease," Laprise explained.
Her results confirm that the risk of virologic failure is a
function of persistent viral load. Thus, a patient with a persistent viral load between
500 and 999 copies/ml after a six-month follow-up runs a five times higher risk of
virologic failure compared to patients whose viral load is undetectable.
However, a persistent low viral load (50 to 199 copies/ml) doubles this risk as much
as an "average" persistent viral load (200 to 499 copies/ml). "This result surprised us
because we did not believe
that a load as low as 50 to 199 copies/ml after 6 months could result in
a significant risk of
virologic failure," said Laprise.
According to her, this represents important clinical data:
for now, there is still no consensus on the therapeutic way forward in the
presence of persistent low viral load. Indeed, in such circumstances, doctors
may decide to alter the patient's therapy or continue to observe the patient
without changing the therapeutic approach. "To the extent that our results
are confirmed by other studies, our findings could provide a new element in
assessing the situation of people with HIV, because of the potential risk
factors our data have uncovered," Laprise said.
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