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Multicenter Study
. 2019 Nov 27;69(12):2145-2152.
doi: 10.1093/cid/ciz129.

Persistent Low-level Viremia While on Antiretroviral Therapy Is an Independent Risk Factor for Virologic Failure

Christie Joya  1   2 , Seung Hyun Won  1   3 , Christina Schofield  1   4 , Tahaniyat Lalani  1   3   5 , Ryan C Maves  1   6 , Karl Kronmann  1   5 , Robert Deiss  1 , Jason Okulicz  1   7 , Brian K Agan  1   3 , Anuradha Ganesan  1   2   3
Affiliations
Multicenter Study

Persistent Low-level Viremia While on Antiretroviral Therapy Is an Independent Risk Factor for Virologic Failure

Christie Joya et al. Clin Infect Dis. .

Abstract

Background: Whether persistent low-level viremia (pLLV) predicts virologic failure (VF) is unclear. We used data from the US Military HIV Natural History Study (NHS), to examine the association of pLLV and VF.

Methods: NHS subjects who initiated combination antiretroviral therapy (ART) after 1996 were included if they had 2 or more VLs measured with a lower limit of detection of ≤50 copies/mL. VF was defined as a confirmed VL ≥200 copies/mL or any VL >1000 copies/mL. Participants were categorized into mutually exclusive virologic categories: intermittent LLV (iLLV) (VL of 50-199 copies/mL on <25% of measurements), pLLV (VL of 50-199 copies/mL on ≥25% of measurements), high-level viremia (hLV) (VL of 200-1000 copies/mL), and continuous suppression (all VL <50 copies/mL). Cox proportional hazards models were used to evaluate the association between VF and LLV; hazard ratios and 95% confidence interval (CI) are presented.

Results: Two thousand six subjects (median age 29.2 years, 93% male, 41% black) were included; 383 subjects (19%) experienced VF. After adjusting for demographics, VL, CD4 counts, ART regimen, prior use of mono or dual antiretrovirals, and time to ART start, pLLV (3.46 [2.42-4.93]), and hLV (2.29 [1.78-2.96]) were associated with VF. Other factors associated with VF include black ethnicity (1.33 [1.06-1.68]) and antiretroviral use prior to ART (1.79 [1.34-2.38]). Older age at ART initiation (0.71 [0.61-0.82]) and non-nucleoside reverse transcriptase inhibitor (0.68 [0.51-0.90]) or integrase strand transfer inhibitor use (0.26 [0.13-0.53]) were protective.

Conclusion: Our data add to the body of evidence that suggests persistent LLV is associated with deleterious virologic consequences.

Keywords: HIV; persistent low-level viremia; virologic failure.

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Figures

Figure 1.
Figure 1.
Study population. Abbreviations: ART, antiretroviral therapy; cLLV, continuous low-level viremia; CS, continuous suppression; hLV, high-level viremia; iLLV, intermittent low-level viremia; LLoD, lower limit of detection; NHS, Natural History Study; VF, virologic failure.
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