| Publication Abstract Display | | Type: Poster | | Title: Correlates of time-to-loss-of-viral-response in CSF and plasma in the CHARTER Cohort. | | Authors: Letendre SL, Ellis RJ, Deutsch R, Clifford D, Collier AC, Gelman B, Marra C, McArthur J, McCutchan JA, Morgello S, Simpson D, Heaton R, Grant I, and the CHARTER Group | | Date: 02-16-2010 | | Abstract:Background: No studies have determined the correlates of the time-to-loss-of-HIV suppression in CSF. To address this, we determined the time-to-loss-of HIV suppression in a large, longitudinal cohort and compared the results in CSF and plasma.
Methods: Longitudinal analysis of HIV+ pts of CHARTER, a 6-center, US-based cohort, who were taking antiretroviral therapy (ART), were suppressed below the lower limit of quantitation (LLQ, 50 c/mL) in CSF (n = 346) or plasma (n = 225) at their initial visit, and had at least two semiannual visits. Kaplan-Meier estimates of time-to-loss-of-viral response (TLVR), defined as a VL > 50 c/mL, were calculated for dichotomized demographic, clinical, and neuropsychological (NP) variables. Baseline variables that were significant at the 10% significance level (Wilcoxon) were analyzed by multivariable Cox proportional hazards models and likelihood ratio tests.
Results: Median duration of ART at the initial visit was 11.1 months in the CSF analysis and 13.0 months in the plasma analysis. In the CSF analysis, 67 events (19%) occurred over a median 9.3 months and 279 (81%) maintained suppression over a median 20.3 months. Baseline predictors of shorter TLVR in CSF were detectable HIV VL in plasma, CD4+ counts < 200, age ≤ 43 years, black ethnicity, protease inhibitor (PI) use, and absence of antidepressant (AD) use. Pts who were NP impaired and reported non-adherence also had shorter TLVR in CSF. Multivariable analysis confirmed that each variable - other than plasma VL and AD use - contributed to the duration of TLVR (model p < 0.0001). In the plasma analysis, 82 events (36%) occurred over a median of 9.3 months and 143 (64%) maintained suppression over a median of 18.0 months. Baseline predictors of TLVR in plasma were CD4+ counts < 200, age ≤ 43 years, black ethnicity, and global NP impairment. Multivariable analysis confirmed that each of these variables were associated with shorter TLVR in plasma (model p < 0.0001).
Conclusions: A substantial minority lost their viral response within a year of entering this cohort study. Predictors of shorter TLVR were similar in CSF and blood except that use of PIs and non-adherence were only associated with shorter TLVR in CSF. Although this cohort-based analysis has an important limitation – initiation of ART was not observed as in a clinical trial – the findings identify that NP impairment is associated with shorter viral responses in CSF and plasma. |
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