Viremia copy-years and mortality among combination antiretroviral therapy-initiating HIV-positive individuals: how much viral load history is enough?

Ruibin Wang, Sabina A. Haberlen, Frank J. Palella, Michael J. Mugavero, Joseph B. Margolick, Bernard J.C. Macatangay, Otoniel Martínez-Maza, Lisa P. Jacobson, Alison G. Abraham

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

OBJECTIVE: Ongoing HIV replication while receiving combination antiretroviral therapy (cART) may reduce survival. Viremia copy-years (VCY) has shown improved mortality risk prediction over single time-point viral load measures. However, the timing of a patient's viral load history most associated with later mortality has not been studied. Here we determined the optimal duration and temporality of viral load history for predicting mortality. DESIGN: Survival analysis among HIV-positive men who initiated cART in the Multicenter AIDS Cohort Study (1995-2015). METHODS: VCY measures were derived from area-under-the-viral load-curve. The overall VCY based upon the complete post-cART viral load history was compared with 20 VCYs derived from viral loads assessed during different shorter time periods (the most recent 1-10 years and initial 1-10 years following cART initiation) for associations with mortality. RESULTS: Each 10-fold increase in VCYs based on the most recent 3-8 years was significantly associated with 23-26% decrease in survival times, a magnitude of effect greater than that of the most recent viral load (16%). These associations were independent of CD4 cell count and single time-point viral loads. In addition, the degree of pre-cART immunodeficiency did not affect the mortality prognostic value of VCY based on viral loads in the most recent 3 years. Conversely, the overall VCY and VCYs based on viral loads immediately following cART initiation were not independent predictors of mortality. CONCLUSION: Among cART-treated men, VCY based upon viral loads in the recent 3 years (six viral loads) has a mortality prognostic value greater than that of the overall VCY and single time-point viral loads, making the former a more feasible measure for use.

Original languageEnglish (US)
Pages (from-to)2547-2556
Number of pages10
JournalAIDS (London, England)
Volume32
Issue number17
DOIs
StatePublished - Nov 13 2018

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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    Wang, R., Haberlen, S. A., Palella, F. J., Mugavero, M. J., Margolick, J. B., Macatangay, B. J. C., Martínez-Maza, O., Jacobson, L. P., & Abraham, A. G. (2018). Viremia copy-years and mortality among combination antiretroviral therapy-initiating HIV-positive individuals: how much viral load history is enough? AIDS (London, England), 32(17), 2547-2556. https://doi.org/10.1097/QAD.0000000000001986