Impact of Low-Level Viremia on Clinical and Virological Outcomes in Treated HIV Infected Patients

ART-CC

Research output: Contribution to journalArticle (Academic Journal)peer-review

47 Citations (Scopus)

Abstract

Background: The goal of antiretroviral therapy (ART) is to reduce HIV-related morbidity and mortality by suppressing HIV replication. The prognostic value of persistent lowlevel viremia (LLV), particularly for clinical outcomes, is unknown. Objective: Assess the association of different levels of LLV with virological failure, AIDS event, and death among HIV-infected patients receiving combination ART.

Methods: We analyzed data from 18 cohorts in Europe and North America, contributing to the ART Cohort Collaboration. Eligible patients achieved viral load below 50 copies/ml within 3-9 months after ART initiation. LLV50-199 was defined as two consecutive viral loads between 50 and 199 copies/ml and LLV200-499 as two consecutive viral loads between 50 and 499 copies/ml, with at least one between 200 and 499 copies/ml. We used Cox models to estimate the association of LLV with virological failure (two consecutive viral loads at least 500 copies/ml or one viral load at least 500 copies/ml, followed by a modification of ART) and AIDS event/death.

Results: Among 17 902 patients, 624 (3.5%) experienced LLV50-199 and 482 (2.7%) LLV200-499. Median follow-up was 2.3 and 3.1 years for virological and clinical outcomes, respectively. There were 1903 virological failure, 532 AIDS events and 480 deaths. LLV200-499 was strongly associated with virological failure [adjusted hazard ratio (aHR) 3.97, 95% confidence interval (CI) 3.05-5.17]. LLV50-199 was weakly associated with virological failure (aHR 1.38, 95% CI 0.96-2.00). LLV50-199 and LLV200-499 were not associated with AIDS event/death (aHR 1.19, 95% CI 0.78- 1.82; and aHR 1.11, 95% CI 0.72-1.71, respectively).

Conclusion: LLV200-499 was strongly associated with virological failure, but not with AIDS event/death. Our results support the US guidelines, which define virological failure as a confirmed viral load above 200 copies/ml.

Original languageEnglish
Pages (from-to)373-383
Number of pages11
JournalAIDS
Volume29
Issue number3
DOIs
Publication statusPublished - 28 Jan 2015

Keywords

  • AIDS event
  • Death
  • HIV
  • Low-level viremia
  • Virological failure

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