Transient detectable viremia and the risk of viral rebound in patients from the Swiss HIV Cohort Study. BMC Infectious Diseases
Young et al. investigated whether the level of transient HIV RNA in blood plasma (‘blip’ magnitude) is predictive of subsequent viral rebound. They found a gradual increase in the relative risk of viral rebound with increasing blip magnitude (hazard ratio 1.09 per 100 copies), corresponding to an estimated hazard ratio of nearly 1.5 using a threshold of 200 copies/mL. Reporting non-adherence and not responding to questions on adherence were associated with a higher risk of viral rebound. The risk of viral rebound increased with both the magnitude of the first blip and the number of blips per suppression episode.
In conclusion, this study suggests that blips in excess of 200 copies/mL are likely to be due to non-adherence rather than due to random variation in residual viremia and should prompt a discussion about adherence.