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Dr Charlotte CHARPENTIER Laboratoire de Virologie CHU Bichat-Claude Bernard

Poster WEPDB0102. Persistent Low-Level HIV-1 RNA between 20 and 50 copies/mL in Antiretroviral-Treated Patients: Associated Factors and Virological Outcome. Dr Charlotte CHARPENTIER Laboratoire de Virologie CHU Bichat-Claude Bernard

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Dr Charlotte CHARPENTIER Laboratoire de Virologie CHU Bichat-Claude Bernard

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  1. Poster WEPDB0102 Persistent Low-Level HIV-1 RNA between 20 and 50 copies/mL in Antiretroviral-Treated Patients: Associated Factors and Virological Outcome Dr Charlotte CHARPENTIER Laboratoire de Virologie CHU Bichat-Claude Bernard Groupe Hospitalier « Hôpitaux Universitaires Paris Nord Val de Seine » Université Paris Diderot - Paris 7

  2. BACKGROUND • Since the availability of viral load (VL) assay with a threshold of 20 copies/mL, some patients display VL values between 20 and 50 copies/mL. • The aims of our study were to: • (i) identify factors associated with low-level viremia (LLV) in patients receiving stable suppressive antiretroviral therapy (cART); • (ii) assess virological outcome during the year following LLV detection. PATIENTS AND METHODS • Retrospective study among the 4820 patients followed in our institution fulfilling the inclusion criteria: (i) stable cART for at least 6 months; (ii) all VL <50 copies/mL; and (iii) at least 3 VL determinations during the one-year inclusion period. • We compared patients with all VL <20 copies/mL (Group LLV-) and patients with at least 2 VL between 20 and 50 copies/mL (Group LLV+). • All patients were then followed-up during 1 year.

  3. RESULTS (1) • Among the 656 patients included, 38 (5.8%) were in group LLV+. • The nature of the ongoing cART did not differ between LLV- and LLV+ groups. • In the multivariate analysis, only CDC clinical stage B/C at study inclusion and a higher “Blip Ratio” before study inclusion were independently associated with LLV. “Blip Ratio” was defined as: (number of VL >50 copies/mL)/(number of VL determinations)

  4. RESULTS (2) • During the follow-up period, the proportion of patients experiencing virological failure was not different between the 2 groups • During the follow-up period 40% of patients shifted from LLV+ to LLV- status. CONCLUSIONS • LLV was infrequent in our series and the one-year follow-up did not evidence a higher rate of virological failure than in patients always fully-suppressed. • LLV seems to be a transient phenomenon that might be driven by residual ongoing viral replication and/or viral release and/or accuracy of VL assay in lower values. • These results suggest that LLV should not drive therapeutic modifications. However, clinical trials to assess potential benefit of therapeutic interventions in patients exhibiting persistent LLV between 20 and 50 copies/mL are needed to establish the management of these patients.

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