Low level viremia and virologic failure in persons with HIV infection treated with antiretroviral therapy

Julia Fleming, W C Mathews, Richard M Rutstein, Judith Aberg, Charurut Somboonwit, Laura W Cheever, Stephen A Berry, Kelly A Gebo, Richard D Moore
AIDS 2019 July 10

BACKGROUND: The clinical management of low level viremia (LLV) remains unclear. The objective of this study was to investigate the association of blips and LLV with virologic failure.

METHODS: We enlisted patients who newly enrolled into the HIV Research Network between 2005-2015, had HIV-1 RNA >200 c/mL, and were either ART-naïve or ART-experienced and not on ART. Patients were included who achieved virologic suppression (≤ 50 on two consecutive viral loads) and had ≥ 2 viral loads following suppression. Blips and LLV (≥ 2 consecutive > 51 c/mL) were categorized separately into 3 categories: no blips/LLV, 51-200, 201-500. Cox proportional hazards regression was used to assess association between rates of blips/LLV and virologic failure (two consecutive >500).

RESULTS: The 2795 patients were mostly male (75.4%), black (50.3%), and MSM (52.9%). Median age was 38 years old (IQR 29-48). Most patients (88.8%) were ART-naïve at study entry. Overall, 283 (10.1%) patients experienced virologic failure. A total of 152 (5.4%) patients experienced LLV to 51-200 and 110 (3.9%) patients experienced LLV to 201-500. Both LLV 51-200 (aHR 1.83 [1.10,3.04]) and LLV 201-500 (aHR 4.26 [2.65,6.86]) were associated with virologic failure. In sensitivity analysis excluding ART experienced patients, the association between LLV51-200 and virologic failure was not statistically significant.

CONCLUSIONS: LLV between 201-500 was associated with virologic failure, as was LLV between 51-200, particularly among ART experienced patients. Patients with LLV below the current DHHS threshold for virologic failure (persistent viremia ≥ 200) may require more intensive monitoring because of increased risk for virologic failure.


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