“Episodes of transient HIV viraemia (blips) in HIV-multi-experienced patients: the role of adherence”

Patients under combined antiretroviral therapy (cART) can experience unexplained episodes of transient HIV-RNA<1000 copies/ml preceded and followed by undetectable viraemia. The commonest hypothesis for blips is that are due to reduced adherence. It is not clear whether blips predict future virologic failure. Forty-five HIV-infected experienced patients with episodes of blips under optimal cART for at least 48 weeks were studied for level of adherence, CD4+, HIV-RNA, genotyping mutations and levels of adherence. All patients had been heavily pretreated. Good or optimal adherence was reported for all patients. The mean number of viral blips was 1.89. No statistical association was found between the number of blips and adherence scores. In this study patients with history of multiple blips presented a 28.8% risk of virologic failure despite good or optimal levels of adherence. Levels of adherence cannot always explain transient relapse of viraemia and other factors probably sustain blips. In addition, some patients with blips experienced a subsequent virologic failure despite good or optimal adherence. Changing therapy may be a prudent strategy for preserving future therapeutic options in experienced patients with blips.