AIDS (London, England) · 2025
Low-level viremia linked to virological failure but not clinical events.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Bernal Enrique, Martínez-Rodríguez Rodrigo, Gómez José Miguel, Tomás Cristina, García-Villalba Eva, Valero Salvador, Muñoz Ángeles, Alcaraz Antonia, Díez Cristina, García-Fraile Lucio J, Gómez-García Teresa, Navarro-Marcotegui María, Alemán-Valls María Remedios, Olalla Julián, Masiá Mar, Gutiérrez Félix, and Cohort of the Spanish HIV/AIDS Research Network (CoRIS)
Аннотация
INTRODUCTION: The main objective of antiretroviral therapy (ART) for people with HIV (PWH) is to maintain an undetectable viral load. This study evaluates the association between low-level viremia (LLV) (50-200 copies/ml) and virological failure, AIDS, and severe non-AIDS events, as well as the impact of sociodemographic and clinical factors.
MATERIALS AND METHODS: Data were collected from the Spanish HIV/AIDS research network (CoRIS), comprising ART-naive adults recruited from 47 centers across Spain. Eligible participants were those who achieved viral suppression (viral load <200 copies/ml) within 3-9 months post-ART initiation and had follow-up data. Participants were classified into two groups: No-LLV (viral load ≤50 copcies/ml or a single measurement >51 but <1000 copies/ml) and LLV1 (51-199 copies/ml in two consecutive measurements). The outcomes included virological failure, AIDS, and severe non-AIDS events (NAE). Statistical analyses involved Competing risk analysis and multinomial logistic regression.
RESULTS: Of 12 110 participants, 89.7% were No-LLV and 10.3% LLV1. LLV groups had higher median age and lower CD4 + counts. Virological failure occurred in 12.3% of LLV1 compared to 4.68% in the No-LLV group ( P < 0.001). In the competitive risk analysis, the hazard ratio for virological failure of LLV1 was 1.39 [97.5% confidence interval (CI) 1.28-1.53, P < 0.0001], ART from 2016 to 2021 was 0.70 (97.5% CI 0.64-0.77, P < 0.001), ART with protease inhibitor was 1.09 (97.5% CI 1.01-1.19, P < 0.001), HIV viral load at least 100 000 copies/ml 1.17 (97.5% CI, 1.01-1.35; P = 0.036) and CD4 + cell count greater than 200 cells/μl was 0.73 (97.5% CI 0.61-0.87, P < 0.001). LLV1 were not associated with an increased risk of AIDS, mortality or NAE.
CONCLUSION: LLV (50-200 copies/ml) was associated with an increased risk of virological failure. However, it was not linked to a higher likelihood of clinical events (AIDS-related, non-AIDS-related, or death). Therefore, while close monitoring is necessary due to the risk of virological failure, these findings provide reassurance as LLV does not translate into adverse clinical outcomes.
MATERIALS AND METHODS: Data were collected from the Spanish HIV/AIDS research network (CoRIS), comprising ART-naive adults recruited from 47 centers across Spain. Eligible participants were those who achieved viral suppression (viral load <200 copies/ml) within 3-9 months post-ART initiation and had follow-up data. Participants were classified into two groups: No-LLV (viral load ≤50 copcies/ml or a single measurement >51 but <1000 copies/ml) and LLV1 (51-199 copies/ml in two consecutive measurements). The outcomes included virological failure, AIDS, and severe non-AIDS events (NAE). Statistical analyses involved Competing risk analysis and multinomial logistic regression.
RESULTS: Of 12 110 participants, 89.7% were No-LLV and 10.3% LLV1. LLV groups had higher median age and lower CD4 + counts. Virological failure occurred in 12.3% of LLV1 compared to 4.68% in the No-LLV group ( P < 0.001). In the competitive risk analysis, the hazard ratio for virological failure of LLV1 was 1.39 [97.5% confidence interval (CI) 1.28-1.53, P < 0.0001], ART from 2016 to 2021 was 0.70 (97.5% CI 0.64-0.77, P < 0.001), ART with protease inhibitor was 1.09 (97.5% CI 1.01-1.19, P < 0.001), HIV viral load at least 100 000 copies/ml 1.17 (97.5% CI, 1.01-1.35; P = 0.036) and CD4 + cell count greater than 200 cells/μl was 0.73 (97.5% CI 0.61-0.87, P < 0.001). LLV1 were not associated with an increased risk of AIDS, mortality or NAE.
CONCLUSION: LLV (50-200 copies/ml) was associated with an increased risk of virological failure. However, it was not linked to a higher likelihood of clinical events (AIDS-related, non-AIDS-related, or death). Therefore, while close monitoring is necessary due to the risk of virological failure, these findings provide reassurance as LLV does not translate into adverse clinical outcomes.