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Epidemiology:
doi: 10.1097/EDE.0b013e3181ce9950
Methodologic Issues in Environmental Exposures: Mixtures and Limits of Detection: Original Article

The Effect of HAART on HIV RNA Trajectory Among Treatment-naïve Men and Women: A Segmental Bernoulli/Lognormal Random Effects Model With Left Censoring

Chu, Haitaoa; Gange, Stephen J.b; Li, Xiuhongb; Hoover, Donald R.c; Liu, Chenglongd; Chmiel, Joan S.e; Jacobson, Lisa P.b

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Abstract

Background: Highly active antiretroviral therapy (HAART) rapidly suppresses human immunodeficiency virus (HIV) viral replication and reduces circulating viral load, but the long-term effects of HAART on viral load remain unclear.

Methods: We evaluated HIV viral load trajectories over 8 years following HAART initiation in the Multicenter AIDS Cohort Study and the Women's Interagency HIV Study. The study included 157 HIV-infected men and 199 HIV-infected women who were antiretroviral naive and contributed 1311 and 1837 semiannual person-visits post-HAART, respectively. To account for within-subject correlation and the high proportion of left-censored viral loads, we used a segmental Bernoulli/lognormal random effects model.

Results: Approximately 3 months (0.30 years for men and 0.22 years for women) after HAART initiation, HIV viral loads were optimally suppressed (ie, with very low HIV RNA) for 44% (95% confidence interval = 39%–49%) of men and 43% (38%–47%) of women, whereas the other 56% of men and 57% of women had on average 2.1 (1.5–2.6) and 3.0 (2.7–3.2) log10 copies/mL, respectively.

Conclusion: After 8 years on HAART, 75% of men and 80% of women had optimal suppression, whereas the rest of the men and women had suboptimal suppression with a median HIV RNA of 3.1 and 3.7 log10 copies/mL, respectively.

© 2010 Lippincott Williams & Wilkins, Inc.

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