Impact of Low-Level Viraemia on Virological Failure in HIV-1-Infected Patients with Stable Antiretroviral Treatment

Abstract

Nearly one-fifth of patients on suppressive ART showed LLV and 8% of them developed VF. HIV RNA >200 copies/ml was the strongest predictor of VF. Over half of patients with persistent viraemia <200 copies/ml showed VF.

Evaluation of HIV-DNA and inflammatory markers in HIV-infected individuals with different viral load patterns

“…However, since the remaining patients were treated with INIs combined with different drugs we believe that this result may be due to a selection bias, since patients starting therapeutic regimen containing integrase inhibitor, were mostly represented by patients with more previous treatment failures and with a history of non-adherence to ART. The same consideration could explain, at least in part, the discrepancy of our finding with the literature data reporting that PIs containing regimens increase the risk to have LLV [ 34 , 35 ].…”

Studying patterns and predictors of HIV viral suppression using A Big Data approach: a research protocol

“…Furthermore, the threshold of LLV at which it would be predictive of VF varies. Some studies suggest a threshold of > 200 copies/ml as being associated with VF; yet other studies suggest a higher threshold (i.e., VL > 400 copies/ml) [ 16 , 17 ].…”

“…According to the US CDC’s HIV Prevention Progress Report 2019, viral suppression remains lowest among persons ≤ 34 years, Blacks/African Americans, persons who inject drugs, and heterosexuals [ 18 , 19 ]. The clinical indicators of HIV diagnosis (e.g., pre-antiretroviral therapy [ART] CD4 counts, pre-ART VL level) are important in determining subsequent virologic success or failure after initiation of ART [ 16 , 19 – 21 ]. Individuals who are more immunocompromised (e.g., low baseline CD4 counts, or opportunistic illnesses) at HIV diagnosis are more likely to develop VF [ 16 , 19 – 21 ].…”

“…The clinical indicators of HIV diagnosis (e.g., pre-antiretroviral therapy [ART] CD4 counts, pre-ART VL level) are important in determining subsequent virologic success or failure after initiation of ART [ 16 , 19 – 21 ]. Individuals who are more immunocompromised (e.g., low baseline CD4 counts, or opportunistic illnesses) at HIV diagnosis are more likely to develop VF [ 16 , 19 – 21 ]. Treatment history, including earlier ART initiation [19], no prior ART use before treatment [ 20 ], prior use of mono- or dual- antiretrovirals [ 22 ], longer duration of therapy [ 20 ], and boosted protease inhibitor (PI)-based regimen [ 20 ], also impacts success or failure of sustained viral suppression [ 16 , 21 ].…”

“…Individuals who are more immunocompromised (e.g., low baseline CD4 counts, or opportunistic illnesses) at HIV diagnosis are more likely to develop VF [ 16 , 19 – 21 ]. Treatment history, including earlier ART initiation [19], no prior ART use before treatment [ 20 ], prior use of mono- or dual- antiretrovirals [ 22 ], longer duration of therapy [ 20 ], and boosted protease inhibitor (PI)-based regimen [ 20 ], also impacts success or failure of sustained viral suppression [ 16 , 21 ]. Apart from individual-level factors, considerable interest remains in understanding how social and structural determinants of health affect the HIV treatment continuum, including viral suppression.…”