536-M. Viral Rebound after Suppression with HAART: Experience from 237 People with Viral Load < 50 copies/mL Followed for up to 4.4 Years

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Session 72 Poster Session
Treatment Interruption
Session Time: 4:30-6:30 pm
Room 4E-F

536-M.

Viral Rebound after Suppression with HAART: Experience from 237 People with Viral Load < 50 copies/mL Followed for up to 4.4 Years
F. Lampe, M. A. Johnson, C. Loveday, M. Youle, D. Ransom, C. Sabin, M. Tyrer, and A. N. Phillips*
Royal Free Hosp. Clin., Univ, Coll. of London, UK

Background: It is important to characterize the long-term durability of viral suppression on HAART regimens, but few existing clinical trials are sufficiently long-lasting to provide this.
Methods: We followed all 237 people from the Royal Free Hospital Clinic who were naďve to antiretrovirals when they started a HAART regimen (3 nucs including aba, 2 nucs + 1 NNRTI or 2 nucs + PI [including rit boosted]), reached a viral load < 400 copies/mL (within 32 weeks) and also reached a viral load < 50 copies/mL without previous viral rebound. Viral rebound was defined as two consecutive values > 400 copies/mL. When viral rebound was associated with stopping of all drugs, follow-up time was right censored at this point.
Results: Subjects were 21% female; HIV exposures were homosexual sex 60%, heterosexual sex 34%; median age 35. HAART was started on median date December 1998 (IQR September 1996 - November 2000). Baseline median viral load 5.3 log copies/mL, CD4 count 193 /mm³. Drugs in the initial regimen were nucs: zdv/3tc 53%, d4T/3tc 33%, other 14%; other drugs: nev 24%, efa 19%, ind 14%, rit 9%, nel 21%, rit boosted PI 12%. Median time from start of HAART to first measured value < 50 copies/mL was 180 days. 1342 viral load measures were made over a total 347 person-years of follow-up after the first viral load < 50 copies/mL - a median of 1 measure per 13.5 weeks. Maximum follow-up was 4.4 years. Overall 13 people (5.4%) experienced viral rebound on therapy (rate 0.037 per person-year) representing 1 person with viral rebound per 26.7 person-years of follow-up. There was a (non-significant) trend towards lower rebound rate with increasing time from start of HAART.
Conclusions: Viral suppression on HAART for people with no prior nucleoside experience is proving extremely durable in those that can tolerate these regimens over long periods.

Š2002 9^th Conference on Retroviruses and Opportunistic Infections