HIV Digest	HIV Digest Archive

In HIV-infected patients, a lower level of HIV achieved in response to therapy is a predictor of long-term virologic suppression. When patients interrupt therapy or when the potency of a regimen is reduced, abrupt elevations in HIV levels are observed. However, transient smaller elevations in HIV levels are also frequently observed in patients who maintain HIV levels of less than 200 copies/mL with potent therapy. These transient episodes have been described as intermittent viremia or "blips." What they may mean for predicting long-term virologic suppression has not been established.

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To determine the prevalence and predictive value of intermittent viremia, researchers conducted a retrospective analysis of subjects in two clinical trials.

Intermittent viremia was associated with a higher steady state of viral replication, but not virologic failure over 4.5 years of observation.

The authors explained that "if blips or low-level intermittent viremia are not associated with greater rates of virologic failure for as long as 4.5 years, then it may not be necessary to switch or intensify therapy until patients exhibit higher levels. Unnecessary regimen switching may result in disruption of a patient's medication routine, toxic effects from new drugs, and premature discarding of useful drugs.... A higher HIV level that would trigger a therapy change may preserve the number of drugs available for future therapeutic regimens."

Editor's Note: from JAMA