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Jennifer
Lee
Author
Department of Epidemiology
Gillings School of Global Public Health
Mortality and cancer risk in HIV patients with incomplete viral suppression after antiretroviral therapy initiation
Advances in combination antiretroviral therapy (ART) have led to prolonged survival among people infected with HIV, with clinical focus shifting from acute illnesses to chronic diseases, including malignancies. Effective ART commonly suppresses viral load levels to below the detection limit of assays used in clinical practice in the US, but not all patients on ART are able to achieve virologic suppression to undetectable levels. Detectable HIV RNA under 1,000 copies/mL has been studied as a potential risk factor for increased drug resistance, subsequent virologic failure, and mortality; however, viral load measurements in this range are of uncertain clinical significance. HIV patients with low viral load under 1,000 copies/mL may not be receiving optimal clinical management, and potential adverse consequences of low, detectable HIV RNA, such as the development of cancer and chronic disease, remain unclear. The objective of this project was to examine the clinical significance of low-level detectable HIV RNA under 1,000 copies based on the relationship between a single viral load measurement collected six months after treatment initiation and mortality, and to assess cancer risk among treated HIV patients with low, detectable viral load. We found that HIV patients with a single low-level viral load measurement between 400 to 999 copies/mL shortly after starting therapy experienced a markedly higher 10-year risk of death (20%) compared to those with viral loads under 20 copies/mL (13%). In fact, these patients faced a similar long-term risk of mortality as patients with very high viral loads (between 1,000 to 4 million copies/mL) that indicated overt treatment failure (23%). We also found that the risk of a first cancer diagnosis in the 10 years following therapy initiation was 6.9% in our study sample, and did not vary by viral load after controlling for baseline characteristics. Our overall findings highlight the importance of rapid viral load suppression after therapy initiation, and indicate that HIV patients with incomplete viral suppression shortly after starting antiretroviral therapy may require closer clinical monitoring and intervention, such as intensification or change of therapy, in order to increase the prospect of successful treatment response and improved survival.
Summer 2017
2017
Epidemiology
Public health
Health sciences
antiretroviral therapy, cancer, HIV, left censoring, mortality, viral suppression
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Stephen
Cole
Thesis advisor
Dirk
Dittmer
Thesis advisor
Joseph
Eron
Thesis advisor
William
Miller
Thesis advisor
David
Richardson
Thesis advisor
text
Jennifer
Lee
Creator
Department of Epidemiology
Gillings School of Global Public Health
Mortality and cancer risk in HIV patients with incomplete viral suppression
after antiretroviral therapy initiation
Advances in combination antiretroviral therapy (ART) have led to prolonged
survival among people infected with HIV, with clinical focus shifting from acute illnesses
to chronic diseases, including malignancies. Effective ART commonly suppresses viral load
levels to below the detection limit of assays used in clinical practice in the US, but not
all patients on ART are able to achieve virologic suppression to undetectable levels.
Detectable HIV RNA under 1,000 copies/mL has been studied as a potential risk factor for
increased drug resistance, subsequent virologic failure, and mortality; however, viral
load measurements in this range are of uncertain clinical significance. HIV patients with
low viral load under 1,000 copies/mL may not be receiving optimal clinical management, and
potential adverse consequences of low, detectable HIV RNA, such as the development of
cancer and chronic disease, remain unclear. The objective of this project was to examine
the clinical significance of low-level detectable HIV RNA under 1,000 copies based on the
relationship between a single viral load measurement collected six months after treatment
initiation and mortality, and to assess cancer risk among treated HIV patients with low,
detectable viral load. We found that HIV patients with a single low-level viral load
measurement between 400 to 999 copies/mL shortly after starting therapy experienced a
markedly higher 10-year risk of death (20%) compared to those with viral loads under 20
copies/mL (13%). In fact, these patients faced a similar long-term risk of mortality as
patients with very high viral loads (between 1,000 to 4 million copies/mL) that indicated
overt treatment failure (23%). We also found that the risk of a first cancer diagnosis in
the 10 years following therapy initiation was 6.9% in our study sample, and did not vary
by viral load after controlling for baseline characteristics. Our overall findings
highlight the importance of rapid viral load suppression after therapy initiation, and
indicate that HIV patients with incomplete viral suppression shortly after starting
antiretroviral therapy may require closer clinical monitoring and intervention, such as
intensification or change of therapy, in order to increase the prospect of successful
treatment response and improved survival.
Summer 2017
2017
Epidemiology
Public health
Health sciences
antiretroviral therapy, cancer, HIV, left censoring,
mortality, viral suppression
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting
institution
Epidemiology
Stephen
Cole
Thesis advisor
Dirk
Dittmer
Thesis advisor
Joseph
Eron
Thesis advisor
William
Miller
Thesis advisor
David
Richardson
Thesis advisor
text
Jennifer
Lee
Creator
Department of Epidemiology
Gillings School of Global Public Health
Mortality and cancer risk in HIV patients with incomplete viral suppression after antiretroviral therapy initiation
Advances in combination antiretroviral therapy (ART) have led to prolonged survival among people infected with HIV, with clinical focus shifting from acute illnesses to chronic diseases, including malignancies. Effective ART commonly suppresses viral load levels to below the detection limit of assays used in clinical practice in the US, but not all patients on ART are able to achieve virologic suppression to undetectable levels. Detectable HIV RNA under 1,000 copies/mL has been studied as a potential risk factor for increased drug resistance, subsequent virologic failure, and mortality; however, viral load measurements in this range are of uncertain clinical significance. HIV patients with low viral load under 1,000 copies/mL may not be receiving optimal clinical management, and potential adverse consequences of low, detectable HIV RNA, such as the development of cancer and chronic disease, remain unclear. The objective of this project was to examine the clinical significance of low-level detectable HIV RNA under 1,000 copies based on the relationship between a single viral load measurement collected six months after treatment initiation and mortality, and to assess cancer risk among treated HIV patients with low, detectable viral load. We found that HIV patients with a single low-level viral load measurement between 400 to 999 copies/mL shortly after starting therapy experienced a markedly higher 10-year risk of death (20%) compared to those with viral loads under 20 copies/mL (13%). In fact, these patients faced a similar long-term risk of mortality as patients with very high viral loads (between 1,000 to 4 million copies/mL) that indicated overt treatment failure (23%). We also found that the risk of a first cancer diagnosis in the 10 years following therapy initiation was 6.9% in our study sample, and did not vary by viral load after controlling for baseline characteristics. Our overall findings highlight the importance of rapid viral load suppression after therapy initiation, and indicate that HIV patients with incomplete viral suppression shortly after starting antiretroviral therapy may require closer clinical monitoring and intervention, such as intensification or change of therapy, in order to increase the prospect of successful treatment response and improved survival.
Summer 2017
2017
Epidemiology
Public health
Health sciences
antiretroviral therapy, cancer, HIV, left censoring, mortality, viral suppression
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Stephen
Cole
Thesis advisor
Dirk
Dittmer
Thesis advisor
Joseph
Eron
Thesis advisor
William
Miller
Thesis advisor
David
Richardson
Thesis advisor
text
Jennifer
Lee
Creator
Department of Epidemiology
Gillings School of Global Public Health
Mortality and cancer risk in HIV patients with incomplete viral suppression after antiretroviral therapy initiation
Advances in combination antiretroviral therapy (ART) have led to prolonged survival among people infected with HIV, with clinical focus shifting from acute illnesses to chronic diseases, including malignancies. Effective ART commonly suppresses viral load levels to below the detection limit of assays used in clinical practice in the US, but not all patients on ART are able to achieve virologic suppression to undetectable levels. Detectable HIV RNA under 1,000 copies/mL has been studied as a potential risk factor for increased drug resistance, subsequent virologic failure, and mortality; however, viral load measurements in this range are of uncertain clinical significance. HIV patients with low viral load under 1,000 copies/mL may not be receiving optimal clinical management, and potential adverse consequences of low, detectable HIV RNA, such as the development of cancer and chronic disease, remain unclear. The objective of this project was to examine the clinical significance of low-level detectable HIV RNA under 1,000 copies based on the relationship between a single viral load measurement collected six months after treatment initiation and mortality, and to assess cancer risk among treated HIV patients with low, detectable viral load. We found that HIV patients with a single low-level viral load measurement between 400 to 999 copies/mL shortly after starting therapy experienced a markedly higher 10-year risk of death (20%) compared to those with viral loads under 20 copies/mL (13%). In fact, these patients faced a similar long-term risk of mortality as patients with very high viral loads (between 1,000 to 4 million copies/mL) that indicated overt treatment failure (23%). We also found that the risk of a first cancer diagnosis in the 10 years following therapy initiation was 6.9% in our study sample, and did not vary by viral load after controlling for baseline characteristics. Our overall findings highlight the importance of rapid viral load suppression after therapy initiation, and indicate that HIV patients with incomplete viral suppression shortly after starting antiretroviral therapy may require closer clinical monitoring and intervention, such as intensification or change of therapy, in order to increase the prospect of successful treatment response and improved survival.
2017-08
2017
Epidemiology
Public health
Health sciences
antiretroviral therapy, cancer, HIV, left censoring, mortality, viral suppression
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Stephen
Cole
Thesis advisor
Dirk
Dittmer
Thesis advisor
Joseph
Eron
Thesis advisor
William
Miller
Thesis advisor
David
Richardson
Thesis advisor
text
Jennifer
Lee
Creator
Department of Epidemiology
Gillings School of Global Public Health
Mortality and cancer risk in HIV patients with incomplete viral suppression after antiretroviral therapy initiation
Advances in combination antiretroviral therapy (ART) have led to prolonged survival among people infected with HIV, with clinical focus shifting from acute illnesses to chronic diseases, including malignancies. Effective ART commonly suppresses viral load levels to below the detection limit of assays used in clinical practice in the US, but not all patients on ART are able to achieve virologic suppression to undetectable levels. Detectable HIV RNA under 1,000 copies/mL has been studied as a potential risk factor for increased drug resistance, subsequent virologic failure, and mortality; however, viral load measurements in this range are of uncertain clinical significance. HIV patients with low viral load under 1,000 copies/mL may not be receiving optimal clinical management, and potential adverse consequences of low, detectable HIV RNA, such as the development of cancer and chronic disease, remain unclear. The objective of this project was to examine the clinical significance of low-level detectable HIV RNA under 1,000 copies based on the relationship between a single viral load measurement collected six months after treatment initiation and mortality, and to assess cancer risk among treated HIV patients with low, detectable viral load. We found that HIV patients with a single low-level viral load measurement between 400 to 999 copies/mL shortly after starting therapy experienced a markedly higher 10-year risk of death (20%) compared to those with viral loads under 20 copies/mL (13%). In fact, these patients faced a similar long-term risk of mortality as patients with very high viral loads (between 1,000 to 4 million copies/mL) that indicated overt treatment failure (23%). We also found that the risk of a first cancer diagnosis in the 10 years following therapy initiation was 6.9% in our study sample, and did not vary by viral load after controlling for baseline characteristics. Our overall findings highlight the importance of rapid viral load suppression after therapy initiation, and indicate that HIV patients with incomplete viral suppression shortly after starting antiretroviral therapy may require closer clinical monitoring and intervention, such as intensification or change of therapy, in order to increase the prospect of successful treatment response and improved survival.
2017
Epidemiology
Public health
Health sciences
antiretroviral therapy, cancer, HIV, left censoring, mortality, viral suppression
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Stephen
Cole
Thesis advisor
Dirk
Dittmer
Thesis advisor
Joseph
Eron
Thesis advisor
William
Miller
Thesis advisor
David
Richardson
Thesis advisor
text
2017-08
Jennifer
Lee
Creator
Department of Epidemiology
Gillings School of Global Public Health
Mortality and cancer risk in HIV patients with incomplete viral suppression after antiretroviral therapy initiation
Advances in combination antiretroviral therapy (ART) have led to prolonged survival among people infected with HIV, with clinical focus shifting from acute illnesses to chronic diseases, including malignancies. Effective ART commonly suppresses viral load levels to below the detection limit of assays used in clinical practice in the US, but not all patients on ART are able to achieve virologic suppression to undetectable levels. Detectable HIV RNA under 1,000 copies/mL has been studied as a potential risk factor for increased drug resistance, subsequent virologic failure, and mortality; however, viral load measurements in this range are of uncertain clinical significance. HIV patients with low viral load under 1,000 copies/mL may not be receiving optimal clinical management, and potential adverse consequences of low, detectable HIV RNA, such as the development of cancer and chronic disease, remain unclear. The objective of this project was to examine the clinical significance of low-level detectable HIV RNA under 1,000 copies based on the relationship between a single viral load measurement collected six months after treatment initiation and mortality, and to assess cancer risk among treated HIV patients with low, detectable viral load. We found that HIV patients with a single low-level viral load measurement between 400 to 999 copies/mL shortly after starting therapy experienced a markedly higher 10-year risk of death (20%) compared to those with viral loads under 20 copies/mL (13%). In fact, these patients faced a similar long-term risk of mortality as patients with very high viral loads (between 1,000 to 4 million copies/mL) that indicated overt treatment failure (23%). We also found that the risk of a first cancer diagnosis in the 10 years following therapy initiation was 6.9% in our study sample, and did not vary by viral load after controlling for baseline characteristics. Our overall findings highlight the importance of rapid viral load suppression after therapy initiation, and indicate that HIV patients with incomplete viral suppression shortly after starting antiretroviral therapy may require closer clinical monitoring and intervention, such as intensification or change of therapy, in order to increase the prospect of successful treatment response and improved survival.
2017
Epidemiology
Public health
Health sciences
antiretroviral therapy, cancer, HIV, left censoring, mortality, viral suppression
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Stephen
Cole
Thesis advisor
Dirk
Dittmer
Thesis advisor
Joseph
Eron
Thesis advisor
William
Miller
Thesis advisor
David
Richardson
Thesis advisor
text
2017-08
Jennifer
Lee
Creator
Department of Epidemiology
Gillings School of Global Public Health
Mortality and cancer risk in HIV patients with incomplete viral suppression after antiretroviral therapy initiation
Advances in combination antiretroviral therapy (ART) have led to prolonged survival among people infected with HIV, with clinical focus shifting from acute illnesses to chronic diseases, including malignancies. Effective ART commonly suppresses viral load levels to below the detection limit of assays used in clinical practice in the US, but not all patients on ART are able to achieve virologic suppression to undetectable levels. Detectable HIV RNA under 1,000 copies/mL has been studied as a potential risk factor for increased drug resistance, subsequent virologic failure, and mortality; however, viral load measurements in this range are of uncertain clinical significance. HIV patients with low viral load under 1,000 copies/mL may not be receiving optimal clinical management, and potential adverse consequences of low, detectable HIV RNA, such as the development of cancer and chronic disease, remain unclear. The objective of this project was to examine the clinical significance of low-level detectable HIV RNA under 1,000 copies based on the relationship between a single viral load measurement collected six months after treatment initiation and mortality, and to assess cancer risk among treated HIV patients with low, detectable viral load. We found that HIV patients with a single low-level viral load measurement between 400 to 999 copies/mL shortly after starting therapy experienced a markedly higher 10-year risk of death (20%) compared to those with viral loads under 20 copies/mL (13%). In fact, these patients faced a similar long-term risk of mortality as patients with very high viral loads (between 1,000 to 4 million copies/mL) that indicated overt treatment failure (23%). We also found that the risk of a first cancer diagnosis in the 10 years following therapy initiation was 6.9% in our study sample, and did not vary by viral load after controlling for baseline characteristics. Our overall findings highlight the importance of rapid viral load suppression after therapy initiation, and indicate that HIV patients with incomplete viral suppression shortly after starting antiretroviral therapy may require closer clinical monitoring and intervention, such as intensification or change of therapy, in order to increase the prospect of successful treatment response and improved survival.
2017
Epidemiology
Public health
Health sciences
antiretroviral therapy, cancer, HIV, left censoring, mortality, viral suppression
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Stephen
Cole
Thesis advisor
Dirk
Dittmer
Thesis advisor
Joseph
Eron
Thesis advisor
William
Miller
Thesis advisor
David
Richardson
Thesis advisor
text
2017-08
Jennifer
Lee
Creator
Department of Epidemiology
Gillings School of Global Public Health
Mortality and cancer risk in HIV patients with incomplete viral suppression after antiretroviral therapy initiation
Advances in combination antiretroviral therapy (ART) have led to prolonged survival among people infected with HIV, with clinical focus shifting from acute illnesses to chronic diseases, including malignancies. Effective ART commonly suppresses viral load levels to below the detection limit of assays used in clinical practice in the US, but not all patients on ART are able to achieve virologic suppression to undetectable levels. Detectable HIV RNA under 1,000 copies/mL has been studied as a potential risk factor for increased drug resistance, subsequent virologic failure, and mortality; however, viral load measurements in this range are of uncertain clinical significance. HIV patients with low viral load under 1,000 copies/mL may not be receiving optimal clinical management, and potential adverse consequences of low, detectable HIV RNA, such as the development of cancer and chronic disease, remain unclear. The objective of this project was to examine the clinical significance of low-level detectable HIV RNA under 1,000 copies based on the relationship between a single viral load measurement collected six months after treatment initiation and mortality, and to assess cancer risk among treated HIV patients with low, detectable viral load. We found that HIV patients with a single low-level viral load measurement between 400 to 999 copies/mL shortly after starting therapy experienced a markedly higher 10-year risk of death (20%) compared to those with viral loads under 20 copies/mL (13%). In fact, these patients faced a similar long-term risk of mortality as patients with very high viral loads (between 1,000 to 4 million copies/mL) that indicated overt treatment failure (23%). We also found that the risk of a first cancer diagnosis in the 10 years following therapy initiation was 6.9% in our study sample, and did not vary by viral load after controlling for baseline characteristics. Our overall findings highlight the importance of rapid viral load suppression after therapy initiation, and indicate that HIV patients with incomplete viral suppression shortly after starting antiretroviral therapy may require closer clinical monitoring and intervention, such as intensification or change of therapy, in order to increase the prospect of successful treatment response and improved survival.
2017
Epidemiology
Public health
Health sciences
antiretroviral therapy, cancer, HIV, left censoring, mortality, viral suppression
eng
Doctor of Philosophy
Dissertation
Epidemiology
Stephen
Cole
Thesis advisor
Dirk
Dittmer
Thesis advisor
Joseph
Eron
Thesis advisor
William
Miller
Thesis advisor
David
Richardson
Thesis advisor
text
2017-08
University of North Carolina at Chapel Hill
Degree granting institution
Jennifer
Lee
Creator
Department of Epidemiology
Gillings School of Global Public Health
Mortality and cancer risk in HIV patients with incomplete viral suppression after antiretroviral therapy initiation
Advances in combination antiretroviral therapy (ART) have led to prolonged survival among people infected with HIV, with clinical focus shifting from acute illnesses to chronic diseases, including malignancies. Effective ART commonly suppresses viral load levels to below the detection limit of assays used in clinical practice in the US, but not all patients on ART are able to achieve virologic suppression to undetectable levels. Detectable HIV RNA under 1,000 copies/mL has been studied as a potential risk factor for increased drug resistance, subsequent virologic failure, and mortality; however, viral load measurements in this range are of uncertain clinical significance. HIV patients with low viral load under 1,000 copies/mL may not be receiving optimal clinical management, and potential adverse consequences of low, detectable HIV RNA, such as the development of cancer and chronic disease, remain unclear. The objective of this project was to examine the clinical significance of low-level detectable HIV RNA under 1,000 copies based on the relationship between a single viral load measurement collected six months after treatment initiation and mortality, and to assess cancer risk among treated HIV patients with low, detectable viral load. We found that HIV patients with a single low-level viral load measurement between 400 to 999 copies/mL shortly after starting therapy experienced a markedly higher 10-year risk of death (20%) compared to those with viral loads under 20 copies/mL (13%). In fact, these patients faced a similar long-term risk of mortality as patients with very high viral loads (between 1,000 to 4 million copies/mL) that indicated overt treatment failure (23%). We also found that the risk of a first cancer diagnosis in the 10 years following therapy initiation was 6.9% in our study sample, and did not vary by viral load after controlling for baseline characteristics. Our overall findings highlight the importance of rapid viral load suppression after therapy initiation, and indicate that HIV patients with incomplete viral suppression shortly after starting antiretroviral therapy may require closer clinical monitoring and intervention, such as intensification or change of therapy, in order to increase the prospect of successful treatment response and improved survival.
2017
Epidemiology
Public health
Health sciences
antiretroviral therapy; cancer; HIV; left censoring; mortality; viral suppression
eng
Doctor of Philosophy
Dissertation
Epidemiology
Stephen
Cole
Thesis advisor
Dirk
Dittmer
Thesis advisor
Joseph
Eron
Thesis advisor
William
Miller
Thesis advisor
David
Richardson
Thesis advisor
text
2017-08
University of North Carolina at Chapel Hill
Degree granting institution
Jennifer
Lee
Creator
Department of Epidemiology
Gillings School of Global Public Health
Mortality and cancer risk in HIV patients with incomplete viral suppression after antiretroviral therapy initiation
Advances in combination antiretroviral therapy (ART) have led to prolonged survival among people infected with HIV, with clinical focus shifting from acute illnesses to chronic diseases, including malignancies. Effective ART commonly suppresses viral load levels to below the detection limit of assays used in clinical practice in the US, but not all patients on ART are able to achieve virologic suppression to undetectable levels. Detectable HIV RNA under 1,000 copies/mL has been studied as a potential risk factor for increased drug resistance, subsequent virologic failure, and mortality; however, viral load measurements in this range are of uncertain clinical significance. HIV patients with low viral load under 1,000 copies/mL may not be receiving optimal clinical management, and potential adverse consequences of low, detectable HIV RNA, such as the development of cancer and chronic disease, remain unclear. The objective of this project was to examine the clinical significance of low-level detectable HIV RNA under 1,000 copies based on the relationship between a single viral load measurement collected six months after treatment initiation and mortality, and to assess cancer risk among treated HIV patients with low, detectable viral load. We found that HIV patients with a single low-level viral load measurement between 400 to 999 copies/mL shortly after starting therapy experienced a markedly higher 10-year risk of death (20%) compared to those with viral loads under 20 copies/mL (13%). In fact, these patients faced a similar long-term risk of mortality as patients with very high viral loads (between 1,000 to 4 million copies/mL) that indicated overt treatment failure (23%). We also found that the risk of a first cancer diagnosis in the 10 years following therapy initiation was 6.9% in our study sample, and did not vary by viral load after controlling for baseline characteristics. Our overall findings highlight the importance of rapid viral load suppression after therapy initiation, and indicate that HIV patients with incomplete viral suppression shortly after starting antiretroviral therapy may require closer clinical monitoring and intervention, such as intensification or change of therapy, in order to increase the prospect of successful treatment response and improved survival.
2017
Epidemiology
Public health
Health sciences
antiretroviral therapy, cancer, HIV, left censoring, mortality, viral suppression
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Stephen
Cole
Thesis advisor
Dirk
Dittmer
Thesis advisor
Joseph
Eron
Thesis advisor
William
Miller
Thesis advisor
David
Richardson
Thesis advisor
text
2017-08
Jennifer
Lee
Creator
Department of Epidemiology
Gillings School of Global Public Health
Mortality and cancer risk in HIV patients with incomplete viral suppression after antiretroviral therapy initiation
Advances in combination antiretroviral therapy (ART) have led to prolonged survival among people infected with HIV, with clinical focus shifting from acute illnesses to chronic diseases, including malignancies. Effective ART commonly suppresses viral load levels to below the detection limit of assays used in clinical practice in the US, but not all patients on ART are able to achieve virologic suppression to undetectable levels. Detectable HIV RNA under 1,000 copies/mL has been studied as a potential risk factor for increased drug resistance, subsequent virologic failure, and mortality; however, viral load measurements in this range are of uncertain clinical significance. HIV patients with low viral load under 1,000 copies/mL may not be receiving optimal clinical management, and potential adverse consequences of low, detectable HIV RNA, such as the development of cancer and chronic disease, remain unclear. The objective of this project was to examine the clinical significance of low-level detectable HIV RNA under 1,000 copies based on the relationship between a single viral load measurement collected six months after treatment initiation and mortality, and to assess cancer risk among treated HIV patients with low, detectable viral load. We found that HIV patients with a single low-level viral load measurement between 400 to 999 copies/mL shortly after starting therapy experienced a markedly higher 10-year risk of death (20%) compared to those with viral loads under 20 copies/mL (13%). In fact, these patients faced a similar long-term risk of mortality as patients with very high viral loads (between 1,000 to 4 million copies/mL) that indicated overt treatment failure (23%). We also found that the risk of a first cancer diagnosis in the 10 years following therapy initiation was 6.9% in our study sample, and did not vary by viral load after controlling for baseline characteristics. Our overall findings highlight the importance of rapid viral load suppression after therapy initiation, and indicate that HIV patients with incomplete viral suppression shortly after starting antiretroviral therapy may require closer clinical monitoring and intervention, such as intensification or change of therapy, in order to increase the prospect of successful treatment response and improved survival.
2017
Epidemiology
Public health
Health sciences
antiretroviral therapy; cancer; HIV; left censoring; mortality; viral suppression
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Stephen
Cole
Thesis advisor
Dirk
Dittmer
Thesis advisor
Joseph
Eron
Thesis advisor
William
Miller
Thesis advisor
David
Richardson
Thesis advisor
text
2017-08
Lee_unc_0153D_17251.pdf
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