Factors associated with HIV viral load "blips" and the relationship between self-reported adherence and efavirenz blood levels on blip occurrence: a case-control study
Abstract
The uncertain etiology of HIV viral load (VL) blips may lead to increased use of clinical resources. We evaluated the association of self-reported adherence (SRA) and antiretroviral (ART) drug levels on blip occurrence in US Military HIV Natural History Study (NHS) participants who initiated the single-tablet regimen efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/FTC/TDF). ART-nave NHS participants started on EFV/FTC/TDF between 2006 and 2013 who achieved VL suppression (<50 copies/mL) within 12 months and had available SRA and stored plasma samples were included. Participants with viral blips were compared with those who maintained VL suppression without blips. Untimed EFV plasma levels were evaluated on consecutive blip and non-blip dates by high performance liquid chromatography, with a level 1 mcg/mL considered therapeutic. SRA was categorized as 85 or <85 . Descriptive statistics were performed for baseline characteristics and univariate and multivariate Cox proportional hazard models were used to assess the relationship between covariates and blip occurrence. A total of 772 individuals met inclusion criteria, including 99 (13 ) blip and 673 (87 ) control participants. African-American was the predominant ethnicity and the mean age was 29 years for both groups. SRA 85 was associated with therapeutic EFV levels at both blip and non-blip time points (P = 0.0026); however no association was observed between blips and SRA or EFV levels among cases. On univariate analysis of cases versus controls, blips were associated with higher mean pre-treatment VL (HR 1.45, 95 CI 1.111.89) and pre-treatment CD4 count <350 cells/L (68.1 vs 49.7 ). Multivariate analysis also showed that blips were associated with a higher mean VL (HR 1.42, 95 CI 1.081.88; P = 0.0123) and lower CD4 count at ART initiation, with CD4 500 cells/L having a protective effect (HR 0.45, 95 CI 0.220.95; P = 0.0365). .
Document Details
- Document Type
- Technical Report
- Publication Date
- Mar 22, 2016
- Accession Number
- AD1075688
Entities
People
- Aaron Farmer
- Anuradha Ganesan
- Brian K. Agan
- Jason F. Okulicz
- Kevin Skevin Akers
- Robert G. Deiss
- Thomas A. O’bryan
- Xun Wang
Organizations
- United States Army Institute of Surgical Research