Smith, CJ; Phillips, AN; Hill, T; Fisher, M; Gazzard, B; Porter, K; Gilson, R; ... United Kingdom HIV Cohort Study; + view all Smith, CJ; Phillips, AN; Hill, T; Fisher, M; Gazzard, B; Porter, K; Gilson, R; Easterbrook, P; Matthias, R; Scullard, G; Johnson, MA; Sabin, CA; United Kingdom HIV Cohort Study; - view fewer (2005) The rate of viral rebound after attainment of an HIV load < 50 copies/mL according to specific antiretroviral drugs in use: Results from a multicenter cohort study. JOURNAL OF INFECTIOUS DISEASES , 192 (8) 1387 - 1397.

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Abstract

Background. Relatively few data are available on the association between the use of specific antiretroviral drugs and the rate of viral rebound in those attaining a viral load (VL) < 50 copies/mL while receiving highly active antiretroviral therapy ( HAART).Methods. Patients achieving a VL < 50 copies/mL for the first time while receiving HAART were followed until viral rebound (2 consecutive VLs > 500 copies/ mL). Pre-HAART antiretroviral-naive patients were analyzed separately from those with nucleoside reverse transcriptase inhibitor (NRTI) experience.Results. Of 3565 suppressed antiretroviral-naive patients, 381 experienced viral rebound ( rate, 6.26 events/100 person-years of follow-up [pyrs][ 95% confidence interval {CI}, 5.63-6.89 events/ 100 pyrs]). For those receiving efavirenz, the rate was 4.08 ( 95% CI, 3.16-5.01) events/ pyrs. Compared with this, the rebound rate for those receiving indinavir was 1.52 times higher ( rate ratio [ RR], 1.52 [ 95% CI, 0.82-2.84]). RRs ( 95% CIs) for other drugs were: soft-gel saquinavir, 0.54 ( 0.07-3.97); nelfinavir, 2.44 ( 1.68-3.54); indinavir/ritonavir, 1.96 ( 1.02-3.77); saquinavir/ritonavir, 1.12 ( 0.48-2.61); lopinavir/ritonavir, 1.23 ( 0.58-2.59); nevirapine, 1.53 ( 1.11-2.10); and abacavir, 2.03 ( 1.26-3.25). Of 810 NRTI-exposed patients, 145 experienced viral rebound ( rate, 8.29 [ 95% CI, 6.94-9.64] events/ pyrs). For those receiving efavirenz, the rate was 5.25 ( 95% CI, 3.11-8.30) events/ pyrs. Compared with this, the RRs ( 95% CIs) were: indinavir, 1.75 ( 0.82-3.73); hard-gel saquinavir, 3.48 ( 0.36-33.37); nelfinavir, 2.64 ( 1.37-5.08); indinavir/ritonavir, 0.32 ( 0.04-2.49); saquinavir/ritonavir, 0.64 ( 0.23-1.80); nevirapine, 1.65 ( 0.90-3.02); and abacavir, 1.82 ( 0.73-4.52).Conclusions. We must make comparisons of antiretroviral outcomes in observational data with caution; however, our results suggest that, in those with VLs < 50 copies/ mL, certain drugs may be associated with higher rebound rates than others.

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