Low-level viremia linked to virological failure but not clinical events

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Bernal E.
  • Martínez-Rodríguez R.
  • Gómez J.M.
  • Tomás C.
  • García-Villalba E.
  • Valero S.
  • Muñoz Á.
  • Alcaraz A.
  • Díez C.
  • García-Fraile L.J.
  • Gómez-García T.
  • Navarro-Marcotegui M.
  • Alemán-Valls M.R.
  • Masiá M.
  • Gutiérrez F.
  • Moreno S.
  • Dalmau D.
  • Navarro M.L.
  • Gonzalez M.I.
  • Garcia F.
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  • Iribarren J.A.
  • Gutierrez F.
  • Rubio R.
  • Vidal F.
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  • Gonzalez J.
  • Muñoz-Fernandez M.A.
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  • Rava M.
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  • Juarez R.
  • Portilla I.
  • Merino E.
  • Agea I.
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  • Giner L.
  • Reus S.
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  • Perez V.
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  • Perez A.
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  • Ocampo A.
  • Alonso J.
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  • Lopez A.
  • Duen˜as C.
  • Lopez M.D.L.F.
  • Novoa C.
  • Telleria P.
  • Garcia S.G.
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  • Du J.
  • Blanco A.M.
  • Aldea I.A.
  • Cañas-Ruano E.
  • Canepa C.
  • Giralt N.G.

Grupos

Abstract

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 þ 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; P¼0.036) and CD4 þ cell count greater than 200 cells/ml 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 (AIDSrelated, 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. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

Datos de la publicación

ISSN/ISSNe:
0269-9370, 1473-5571

AIDS  LIPPINCOTT WILLIAMS & WILKINS

Tipo:
Article
Páginas:
1545-1557
PubMed:
40465818
Enlace a otro recurso:
www.scopus.com
Factor de Impacto:
1,702 SCImago ℠
Cuartil:
Q1 SCImago ℠

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Keywords

  • Adult; Anti-Retroviral Agents; CD4 Lymphocyte Count; Female; HIV Infections; Humans; Male; Middle Aged; Spain; Treatment Failure; Viral Load; Viremia; anti human immunodeficiency virus agent; integrase inhibitor; nonnucleoside reverse transcriptase inhibitor; proteinase inhibitor; ritonavir; RNA directed DNA polymerase inhibitor; antiretrovirus agent; acquired immune deficiency syndrome; adult; antiretroviral therapy; Article; CD4 lymphocyte count; clinical feature; disease association; female; follow up; heterosexuality; human; Human immunodeficiency virus; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; major clinical study; male; middle aged; mortality; multinomial logistic regression; nonhuman; risk assessment; sociodemographics; Spain; Spaniard; treatment outcome; viral load testing; virus load; clinical trial; complication; drug therapy; Human immunodeficiency virus infection; multicenter study; pathology; treatment failure; viremia; virolog

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