Risk of HIV Viral Rebound in the Era of Universal Treatment in a Multi-Center Sample of Persons with HIV in Primary Care

Abstract

Abstract Background Antiretroviral therapy (ART) is recommended for people with HIV (PWH), irrespective of CD4 cell count, to improve their health and reduce the risk of transmission to sexual partners through long-term viral suppression. We identified risk factors for viral rebound among patients with a period of stable viral suppression to inform counseling and monitoring. Methods We conducted a multi-site, retrospective study of PWH with a two-year period of sustained viral suppression in the United States using the Centers for AIDS Research Network of Integrated Clinical Systems cohort. We used multivariable logistic regression to identify characteristics independently associated with any viral rebound [viral load (VL) ≥200 copies/mL] and sustained viral rebound (VL ≥200 copies/mL followed by a VL that was also ≥200 copies/mL within six months), within two years of follow-up. Results Among 3,496 eligible patients with a two-year period of sustained viral suppression, most (90%) continued to have viral suppression over two additional years; 10% experienced viral rebound, and 4% experienced sustained viral rebound. In multivariable analyses, Black race, current smoking, integrase strand transfer inhibitor use, and five-to-nine-year duration of ART were positively associated, and being age ≥50 years was negatively associated, with any viral rebound. Only current smoking and five-to-nine-year (vs. two-to-four-year) duration of ART were positively associated, and being age ≥60 years was negatively associated, with sustained viral rebound. Conclusions Most people retained in clinical care and with HIV viral suppression on ART will have persistent viral suppression. However, some patients may benefit from additional treatment adherence supports.