Lower Incidence of HIV-1 Blips Observed during Integrase Inhibitor-Based Combination Antiretroviral Therapy
Dijkstra, Suzan; Hofstra, L. Marije; Mudrikova, Tania; Wensing, Annemarie M.J.; Oomen, Patrick G.A.; Hoepelman, Andy I.M.; Van Welzen, Berend J.
(2022) Journal of Acquired Immune Deficiency Syndromes, volume 89, issue 5, pp. 575 - 582
(Article)
Abstract
Background:As the nature of viral blips remains unclear, their occurrence often leads to uncertainty. This study compares blip incidence rates during treatment with different combination antiretroviral therapy anchors.Setting:Retrospective cohort study in a tertiary hospital.Methods:All antiretroviral regimens between 2010 and 2020 containing 2 nucleos(-t)ide reverse transcriptase inhibitors and 1 anchor in
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virologically suppressed people living with HIV (PLWH) from our center were evaluated for the occurrence of blips [isolated viral loads (VLs) 50-499 copies/mL between measurements <50 copies/mL]. Factors associated with blips were identified using multivariable generalized estimating equation-based negative binomial models. The relationship between blips and either persistent low-level viremia (consecutive VLs ≥ 50 copies/mL not classified as failure) or virologic failure (consecutive VLs ≥ 200 or 1 VL ≥ 500 copies/mL) was also evaluated.Results:In total, 308 blips occurred during 3405 treatment courses in 1661 PLWH. Compared with a non-nucleoside reverse transcriptase inhibitor anchor, blip incidence was higher for protease inhibitors (incidence rate ratio 1.37; 95% confidence interval 1.05 to 1.78) and lower for integrase inhibitors (INSTIs) (incidence rate ratio 0.64; 95% confidence interval: 0.43 to 0.96). In addition, blips were associated with higher zenith VL, higher VL test frequency, and shorter time since antiretroviral therapy initiation. PLWH experiencing blips were more likely to demonstrate persistent low-level viremia but not virologic failure. Blips led to extra consultations and measurements.Conclusions:INSTI-based regimens display a low number of blips. Although we found no correlation with virologic failure, the occurrence of blips led to an increased clinical burden. Further research is needed to elucidate the implications and underlying mechanisms of these findings.
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Keywords: blips, combination antiretroviral therapy, integrase strand transfer inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, transient viremia, HIV Seropositivity/complications, HIV-1, Antiretroviral Therapy, Highly Active/adverse effects, Reverse Transcriptase Inhibitors/therapeutic use, Humans, HIV Integrase Inhibitors/therapeutic use, Viral Load, Viremia/drug therapy, Incidence, HIV Infections/complications, Retrospective Studies, Infectious Diseases, Pharmacology (medical), Research Support, Non-U.S. Gov't, Journal Article
ISSN: 1525-4135
Publisher: Lippincott Williams and Wilkins
Note: Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
(Peer reviewed)