Factors associated with HIV viral load “blips” and the relationship between self-reported adherence and efavirenz blood levels on blip occurrence: a case–control study

摘要

Background The uncertain etiology of HIV viral load (VL) blips may lead to increased use of clinical resources. We evaluated the association of self-reported adherence (SRA) and antiretroviral (ART) drug levels on blip occurrence in US Military HIV Natural History Study (NHS) participants who initiated the single-tablet regimen efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/FTC/TDF). Methods ART-na?ve NHS participants started on EFV/FTC/TDF between 2006 and 2013 who achieved VL suppression (Results A total of 772 individuals met inclusion criteria, including 99 (13?%) blip and 673 (87?%) control participants. African-American was the predominant ethnicity and the mean age was 29?years for both groups. SRA?≥?85?% was associated with therapeutic EFV levels at both blip and non-blip time points (P?=?0.0026); however no association was observed between blips and SRA or EFV levels among cases. On univariate analysis of cases versus controls, blips were associated with higher mean pre-treatment VL (HR 1.45, 95?% CI 1.11–1.89) and pre-treatment CD4 count Conclusion Blips are commonly encountered in the clinical management of HIV-infected patients. Although blip occurrence was not associated with SRA or EFV blood levels in our study, blips were associated with HIV-related factors of pre-ART high VL and low CD4 count. Additional studies are needed to determine the etiology of blips in HIV-infected patients.