Incomplete viral suppression and mortality in HIV patients after antiretroviral therapy initiation

Jennifer S. Lee*, Stephen R. Cole, David B. Richardson, Dirk P. Dittmer, William C. Miller, Richard D. Moore, Mari Kitahata, Christopher Mathews, Kenneth Mayer, Elvin Geng, Chad J. Achenbach, Joseph J. Eron

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Objective: To determine whether there is a threshold of detectable HIV RNA under 1000 copies/ml after antiretroviral therapy initiation associated with 10-year all-cause mortality. Design: This study included nearly 8000 patients from a US-based multicenter clinical cohort who started antiretroviral therapy between 1 January 1998 and 31 December 2013. Viral load was assessed 6 months after initiation of therapy. Patients were followed from 6 months after therapy initiation (between 1 July 1998 and 30 June 2014) until death, and data were administratively censored after 10 years or on 31 December 2014. Methods: We used nonparametric multiple imputation to account for left-censored viral load measurements, Cox proportional hazards models to estimate all-cause mortality hazard ratios, Nelson-Aalen cumulative hazard estimates to construct risk curves, and inverse probability of exposure weights to standardize estimated hazard ratios and risk curves to the total study population. Results: Plots of standardized hazard ratio estimates and 95% confidence intervals indicated there was no demonstrable viral load threshold between 30 and 500 copies/ml associated with a marked increase in 10-year mortality. The standardized 10-year risk of mortality among patients with viral loads between 400 and 999 copies/ml 6 months after starting treatment was comparable with the risk of mortality among patients with viral loads between 1000 and 4 million copies/ml (20 vs. 23%). Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)1989-1997
Number of pages9
Issue number14
StatePublished - Sep 10 2017


  • antiretroviral therapy
  • clinical cohort
  • left censoring
  • mortality
  • multiple imputation
  • viral suppression

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases


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