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. 2024 Jan;25(1):107-116.
doi: 10.1111/hiv.13541. Epub 2023 Sep 18.

Low-level HIV viraemia during antiretroviral therapy: Longitudinal patterns and predictors of viral suppression

S Elén  1 , P Björkman  1   2 , M Zazzi  3 , M Böhm  4 , E Bernal  5 , A Sönnerborg  6 , O Elvstam  1   7 ; EuResist Network Study Group
Affiliations

Low-level HIV viraemia during antiretroviral therapy: Longitudinal patterns and predictors of viral suppression

S Elén et al. HIV Med. 2024 Jan.

Abstract

Objectives: Our objective was to characterize longitudinal patterns of viraemia and factors associated with viral suppression in people with HIV and low-level viraemia (LLV) during antiretroviral therapy (ART).

Methods: We included people with HIV in the EuResist Integrated Database with LLV following ART initiation after 2005. LLV was defined as two or more consecutive viral load (VL) measurements of 51-199 copies/mL 30-365 days apart after >12 months of ART. Viraemia patterns were analyzed over 24 months. Factors associated with viral suppression at 12 months after LLV episodes were identified using univariable and multivariable logistic regression.

Results: Of 25 113 people with HIV, 2474 (9.9%) had LLV. Among 1387 participants with 24 months of follow-up after LLV, 406 (29%) had persistent suppression, 669 (48%) had transient viraemic episodes, 29 (2%) had persistent LLV, and 283 (20%) had virological failure. Following LLV episodes, the proportion with detectable viraemia declined (p for trend <0.001 and 0.034, in the first and second year, respectively). At 12 months, 68% had undetectable VL, which was associated with suppression before LLV (adjusted odds ratio [aOR] 1.7; 95% confidence interval [CI] 1.2-2.4) and ART modification after LLV (aOR 1.6; 95% CI 1.0-2.4). The following factors were negatively associated with undetectable VL at 12 months: higher VL during LLV (aOR 0.57 per log10 copies/mL; 95% CI 0.37-0.89), injecting drug use (aOR 0.67; 95% CI 0.47-0.96), and regimens with protease inhibitors (aOR 0.65; 95% CI 0.49-0.87) or combined anchor drugs (aOR 0.52; 95% CI 0.32-0.85).

Conclusion: Most people with LLV did not experience sustained viral suppression during 24-month follow-up, supporting the association between LLV and inferior treatment outcome.

Keywords: ART; HIV; low-level viraemia; viral suppression; virological failure.

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