![]() ![]() Some studies have found a correlation between viral blips and subsequent virological failure, whereas others have not. Possible consequences of viral blips are not clear. The large differences are due to different blip definitions and viral load assays. Prior studies have reported blip incidence between 13 and 40 %. ![]() ![]() Other explanations could be stochastic variations, conditions that temporarily could lead to increased HIV replication such as infections or vaccinations, and low drug concentrations in blood because of poor adherence or poor absorption of antiretroviral drugs. There may be several reasons for these viral blips, including technical errors or an influence of the type of blood collection tube used. Įven though the plasma viral load is suppressed to < 50 copies/mL in a majority of treated patients, it may increase to detectable levels from time to time, usually to a maximum of 500 copies/mL, before decreasing to < 50 copies/mL again, so called viral blips. The level of this so-called residual viremia has been demonstrated to be between 1 and 10 copies/mL. When quantified with more sensitive methods, HIV can usually be detected in low concentrations in almost all adherent patients on effective therapy. Most patients on combination antiretroviral therapy (cART) reach the goal of therapy, HIV RNA < 50 copies/mL blood, within three to six months after initiation of cART. Blips were associated with high baseline viral load and an increased risk of subsequent virological failure. The Swedish national HIV-cohort has a low incidence of viral blips (10 %). There was a significant association between viral blips and risk for subsequent virological failure ( p < 0.001). Baseline viral load was higher in subjects with viral blips (median log 10 4.85 copies/mL) compared with subjects without blips (median log 10 4.55 copies/mL) ( p < 0.01). Median follow-up time was 170 weeks (range 97–240). Median blip viral load was 76 copies/mL (range 56–138). Viral blips were defined as a transient viral load between 50 and 500 copies/mL Subjects not suppressed after six months on ART were excluded. HIV-1-infected ART naïve adults who commenced ART 2007–2013 were retrospectively included. We have determined the incidence of blips and investigated important associations in the Swedish HIV-cohort. The clinical significance of these viral blips is uncertain. Many HIV-1-infected patients on suppressive antiretroviral therapy (ART) have transiently elevated HIV RNA levels. ![]()
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