Patients had been on cART for a median of 4.4 years prior to baseline. The majority of patients (1029; 56.3%) were on an NNRTI-based cART regimen after starting new ARVs at baseline. Selleck UK-371804 The main reason reported for starting new ARVs was toxicity or patient/physician choice. Nine hundred and thirty-two patients (51%) only started one new ARV and 349 (19%) started a completely new cART regimen (at least three ARVs). Patients had a median viral load of 4.54 log10 copies/mL when they started cART. The median time to first viral suppression after cART

initiation was 3.0 months (IQR 1.3–7.4 months). Five hundred and eighty-nine patients (68%) experienced at least one viral rebound prior to baseline after cART initiation. Of those patients who had rebounded prior to baseline, 206 (35%) had experienced a viral rebound to >10 000 copies/mL and 137 patients (23.2%) had experienced a viral rebound in the year prior to baseline. Overall, patients had spent a median of 98% (IQR Selleck PF-562271 86–100%) of the time on cART virally suppressed (viral load <500 copies/mL) after cART initiation. After starting a new ARV(s), 451 patients (24.7%) experienced virological failure, with an incidence rate (IR) of 7.3 per 100 person-years of follow-up (PYFU) [95% confidence interval (CI) 6.7–8.0]. Patients who took longer to achieve initial viral

suppression after cART initiation had an increased rate of virological failure after baseline (IRR 1.04 per 6 months longer to achieve suppression; 95% CI 0.99–1.09); however, this difference was not Thalidomide statistically significant (P=0.14). Figure 1 shows the rate of virological failure after

baseline by the number of viral rebounds the patient had experienced prior to baseline. There was a 41% increased rate of virological failure after baseline for each viral rebound experienced prior to baseline (IRR 1.41; 95% CI 1.31–1.51). Patients who had a low viral rebound prior to baseline (501–1000 copies/mL) had a 30% lower rate of virological failure after baseline (IRR 0.70; 95% CI 0.49–1.01; P=0.06) and those who had a medium viral rebound (1001–10 000 copies/mL) had an 18% lower rate (IRR 0.82; 95% CI 0.60–1.10; P=0.19) compared with patients who had experienced a high viral rebound (>10 000 copies/mL) prior to baseline (Fig. 2). There was a higher rate of virological failure in patients who had virally rebounded more recently before baseline (Fig. 3). For example, patients who had virally rebounded in the year prior to baseline had a 3.4-times higher rate of virological failure compared with patients who had never virally rebounded (IRR 3.37; 95% CI 2.59–4.39; P<.0001), whereas there was no significant difference in the rate of virological failure between patients whose last viral rebound was more than 3 years prior and those who had never rebounded (IRR 1.10; 95% CI 0.81–1.49; P=0.54).