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. 2024 Nov 1;38(13):1829-1838.
doi: 10.1097/QAD.0000000000003990. Epub 2024 Aug 28.

Consequences of low-level viremia among women with HIV in the United States

Amalia Aldredge  1   2 , C Christina Mehta  1   3 , Cecile D Lahiri  1   2 , Michael F Schneider  4 , Maria L Alcaide  5 , Kathryn Anastos  6 , Michael Plankey  7 , Audrey L French  8 , Michelle Floris-Moore  9 , Phyllis C Tien  10 , Jodie Dionne  11 , Jack Dehovitz  12 , Lauren F Collins  1   2 , Anandi N Sheth  1   2
Affiliations

Consequences of low-level viremia among women with HIV in the United States

Amalia Aldredge et al. AIDS. .

Abstract

Objective: Investigate the outcomes of women with HIV (WWH) with low-level viremia (LLV).

Design: The prevalence of LLV and potential clinical sequelae, such as virologic failure and non-AIDS comorbidity (NACM) development, are poorly characterized among WWH.

Methods: We analyzed data from the Women's Interagency HIV Study among WWH enrolled from 2003 to 2020 who reported antiretroviral therapy use at least 1 year followed by an HIV-1 viral load less than 200 copies/ml. Consecutive viral load measurements from four semi-annual visits were used to categorize women at baseline as having: virologic suppression (all viral load undetectable), intermittent LLV (iLLV; nonconsecutive detectable viral load up to 199 copies/ml), persistent LLV (pLLV; at least two consecutive detectable viral load up to 199 copies/ml), or virologic failure (any viral load ≥200 copies/ml). Adjusted hazard ratios quantified the association of virologic category with time to incident virologic failure and multimorbidity (≥2 of 5 NACM) over 5-year follow-up.

Results: Of 1598 WWH, baseline median age was 47 years, 64% were Black, 21% Hispanic, and median CD4 + cell count was 621 cells/μl. After excluding 275 women (17%) who had virologic failure at baseline, 58, 19, and 6% were categorized as having virologic suppression, iLLV, and pLLV, respectively. Compared with WWH with virologic suppression, the adjusted hazard ratio [aHR; 95% confidence interval (CI)] for incident virologic failure was 1.88 (1.44-2.46) and 2.51 (1.66-3.79) for iLLV and pLLV, respectively; and the aHR for incident multimorbidity was 0.81 (0.54-1.21) and 1.54 (0.88-2.71) for iLLV and pLLV, respectively.

Conclusion: Women with iLLV and pLLV had an increased risk of virologic failure. Women with pLLV had a trend towards increased multimorbidity risk.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Study design.
Fig. 2
Fig. 2
Flow diagram of inclusion and exclusion of participants.
Fig. 3
Fig. 3
Adjusted survival curves for (a) time to incident virologic failure and (b) time to Incident multimorbidity.
See this image and copyright information in PMC

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