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The significance of HIV 'blips' in resource-limited settings: is it the same? analysis of the treat Asia HIV Observational Database (TAHOD) and the Australian HIV Observational Database (AHOD)

Kanapathipillai R 1 , McManus H 2 , Kamarulzaman A 3 , Lim PL 4 , Templeton DJ 5 , Law M 2 Show all authors , Woolley I 6

Affiliations 

  • 1 Monash Medical Centre, Clayton, Victoria, Australia ; Alfred Hospital, Prahran, Victoria, Australia
  • 2 Kirby Institute, The University of New South Wales, Darlinghurst, New South Wales, Australia
  • 3 University of Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 4 Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
  • 5 Kirby Institute, The University of New South Wales, Darlinghurst, New South Wales, Australia ; RPA Sexual Health, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
  • 6 Monash Medical Centre, Clayton, Victoria, Australia ; Alfred Hospital, Prahran, Victoria, Australia ; Departments of Medicine and Infectious Diseases, Monash University, Clayton, Victoria, Australia
PLoS One, 2014;9(2):e86122.
PMID: 24516527 DOI: 10.1371/journal.pone.0086122

Abstract

INTRODUCTION: Magnitude and frequency of HIV viral load blips in resource-limited settings, has not previously been assessed. This study was undertaken in a cohort from a high income country (Australia) known as AHOD (Australian HIV Observational Database) and another cohort from a mixture of Asian countries of varying national income per capita, TAHOD (TREAT Asia HIV Observational Database).

METHODS: Blips were defined as detectable VL (≥ 50 copies/mL) preceded and followed by undetectable VL (<50 copies/mL). Virological failure (VF) was defined as two consecutive VL ≥50 copies/ml. Cox proportional hazard models of time to first VF after entry, were developed.

RESULTS: 5040 patients (AHOD n = 2597 and TAHOD n = 2521) were included; 910 (18%) of patients experienced blips. 744 (21%) and 166 (11%) of high- and middle/low-income participants, respectively, experienced blips ever. 711 (14%) experienced blips prior to virological failure. 559 (16%) and 152 (10%) of high- and middle/low-income participants, respectively, experienced blips prior to virological failure. VL testing occurred at a median frequency of 175 and 91 days in middle/low- and high-income sites, respectively. Longer time to VF occurred in middle/low income sites, compared with high-income sites (adjusted hazards ratio (AHR) 0.41; p<0.001), adjusted for year of first cART, Hepatitis C co-infection, cART regimen, and prior blips. Prior blips were not a significant predictor of VF in univariate analysis (AHR 0.97, p = 0.82). Differing magnitudes of blips were not significant in univariate analyses as predictors of virological failure (p = 0.360 for blip 50-≤1000, p = 0.309 for blip 50-≤400 and p = 0.300 for blip 50-≤200). 209 of 866 (24%) patients were switched to an alternate regimen in the setting of a blip.

CONCLUSION: Despite a lower proportion of blips occurring in low/middle-income settings, no significant difference was found between settings. Nonetheless, a substantial number of participants were switched to alternative regimens in the setting of blips.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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