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Low-level viraemia, measured as viraemia copy-years, as a prognostic factor for medium-long-term all-cause mortality: a MASTER cohort study.

Low-level viraemia, measured as viraemia copy-years, as a prognostic factor for medium-long-term all-cause mortality: a MASTER cohort study.
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Quiros-Roldan E, Raffetti E, Castelli F, Focà E, Castelnuovo F, Di Pietro M, Gagliardini R, Gori A, Saracino A, Fornabaio C, Sighinolfi L, Di Filippo E, Maggiolo F, Donato F,


Quiros-Roldan E, Raffetti E, Castelli F, Focà E, Castelnuovo F, Di Pietro M, Gagliardini R, Gori A, Saracino A, Fornabaio C, Sighinolfi L, Di Filippo E, Maggiolo F, Donato F, (click to view)

Quiros-Roldan E, Raffetti E, Castelli F, Focà E, Castelnuovo F, Di Pietro M, Gagliardini R, Gori A, Saracino A, Fornabaio C, Sighinolfi L, Di Filippo E, Maggiolo F, Donato F,

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The Journal of antimicrobial chemotherapy 2016 8 19() pii

Abstract
OBJECTIVES
We investigated the association between persistent low-level viraemia, measured as viraemia copy-years (VCY), and all-cause mortality.

METHODS
We included 3271 HIV-infected patients who initiated their first combined ART (cART) during 1998-2012 enrolled in the multicentre Italian MASTER cohort. VCY was defined as the area under the curve of plasma viral load (pVL) and expressed in log10 copies · years/mL. VCY was evaluated from cART initiation until the end of follow-up [VCY-overall (VCY-o)], and stratified into before [VCY-early (VCY-e)] and after [VCY-late (VCY-l)] the eighth month from starting cART, and as the ratio of VCY-l to follow-up duration (VCY-l/FUD).

RESULTS
The risk of death increased of about 40% for higher than the median levels of VCY-o and VCY-e. Compared with subjects with permanently suppressed pVL after the eighth month from starting cART, mortality increased by 70% for those with VCY-l ≥3 log10 copies·years/mL, and by about 20-fold for those with VCY-l/FUD ≥2.3 log10 copies/mL. Patients who maintained low levels of VCY-l (<3 log10 copies · years/mL) or VCY-l/FUD (<2.3 log10 copies/mL) had a risk of death similar to patients with permanently suppressed pVL. CD4 cell count at baseline was predictive of high risk of death only in subjects with VCY-l ≥3 log10 copies · years/mL. CONCLUSIONS
The risk of death did not increase in HIV-infected patients with low levels of VCY-l compared with patients with permanent virological suppression.

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