HIV viral rebound rare after 2 years of consistent suppression, study finds

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A study of almost 4,000 people with HIV and sustained 2-year period of viral suppression found that they were unlikely to experience viral rebound over the next 2 years, supporting treatment as prevention as an HIV prevention strategy.

The study also identified risk factors associated with viral rebound, including Black race, smoking and use of integrase strand transfer inhibitors.

“The objective of this study was to identify risk factors for viral rebound among patients with a period of stable viral suppression, ie, persons potentially eligible to use treatment as prevention for HIV prevention based upon established viral suppression,” Tao Liu, PhD, associate professor of biostatistics at Brown University, and colleagues wrote.

To do so, Liu and colleagues conducted a multisite, retrospective study of people with HIV (PWH) in the United States who were part of the Centers for AIDS Research Network of Integrated Clinical Systems cohort and had a 2-year period of sustained viral suppression.

According to the study, the researchers used multivariable logistic regression to evaluate characteristics associated with any viral rebound (viral load 200 copies/mL or more) and sustained viral rebound (viral load 200 copies/mL or more, followed by a viral load that was also 200 copies/mL or more within 6 months) within 2 years of follow-up.

Overall, 3,496 patients with a 2-year period of sustained viral suppression were included in the study. Of these patients, 90% continued to have viral suppression over 2 additional years, whereas 10% experienced viral rebound and 4% experienced sustained viral rebound.

Additionally, multivariable analyses showed that Black race, being a smoker, integrase strand transfer inhibitor use and 5- to 9-year duration of ART were risk factors for viral rebound, whereas being aged 50 years and older was less likely to be a risk factor for viral rebound.

The researchers also found that current smoking and a 5- to 9-year vs. a 2- to 4-year duration of ART were both risk factors for sustained viral rebound, whereas being 60 years or older was was less likely to be a risk factor for sustained viral rebound.

The authors wrote that these findings suggest that “treatment as prevention could be a viable primary HIV prevention strategy for many patients given the durability of viral suppression.”

“Some patients, including younger patients, may benefit from additional supports to ensure persistence of viral suppression, such as more intensive adherence counseling, interventions to ensure retention in care, and more frequent viral load monitoring,” they concluded.

Source: Liu T, et al. Open Forum Infect Dis. 2023;do:10.1093/ofid/ofad257.

By Caitlyn Stulpin


Source : Healio

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