Factors associated with low-level viraemia in people with HIV starting antiretroviral therapy : A Swedish observational study
Brattgård, Hanna ; Björkman, Per LU
; Nowak, Piotr
; Treutiger, Carl Johan
; Gisslén, Magnus
and Elvstam, Olof
LU
(2022)
In PLoS ONE
17(5).
- Abstract
OBJECTIVE: Low-level viraemia (LLV) occurs in some people with HIV (PWH) receiving antiretroviral therapy (ART) and has been linked to inferior treatment outcomes. We investigated factors associated with LLV in a nationwide cohort of Swedish PWH starting ART.
METHODS: Participants were identified from the InfCareHIV register, with the following inclusion criteria: ART initiation 2006-2017, age >15 years, ≥4 viral load (VL) results available and no documented treatment interruptions or virologic failure (≥2 consecutive VL ≥200 copies/ml) during follow-up. Starting from 6 months after ART initiation, participants were followed for 24 months and categorised as viral suppression (VS; VL <50 copies/ml) or LLV (≥2 consecutive VL... (More)
OBJECTIVE: Low-level viraemia (LLV) occurs in some people with HIV (PWH) receiving antiretroviral therapy (ART) and has been linked to inferior treatment outcomes. We investigated factors associated with LLV in a nationwide cohort of Swedish PWH starting ART.
METHODS: Participants were identified from the InfCareHIV register, with the following inclusion criteria: ART initiation 2006-2017, age >15 years, ≥4 viral load (VL) results available and no documented treatment interruptions or virologic failure (≥2 consecutive VL ≥200 copies/ml) during follow-up. Starting from 6 months after ART initiation, participants were followed for 24 months and categorised as viral suppression (VS; VL <50 copies/ml) or LLV (≥2 consecutive VL 50-199 copies/ml). We analysed the association between the following factors and LLV using multivariable logistic regression: sex, age, pre-ART VL and CD4 count, ART regimen, country of birth, HIV-1 subtype and transmission category.
RESULTS: Among 3383 participants, 3132 (92.6%) had VS and 251 (7.4%) had LLV. In univariable analyses, factors associated with LLV were male sex, higher age, lower pre-ART CD4 count, higher pre-ART VL and ART regimen. After adjustment, the following factors were associated with LLV (adjusted odds ratio; 95% confidence interval): male sex (1.6; 1.1-2.3), higher pre-ART VL (2.7; 2.2-3.3), pre-ART CD4 count <200 cells/μl (1.6; 1.2-2.2), protease inhibitor (PI)-based regimen (1.5; 1.1-2.1), non-standard ART (2.4; 1.0-5.5) and injecting drug use (2.0; 1.1-3.7).
CONCLUSION: Among Swedish PWH, LLV during ART was associated with markers of HIV disease severity before starting ART, male sex, injecting drug use and use of PI-based or non-standard ART regimens.
(Less)
- author
- Brattgård, Hanna
; Björkman, Per
LU
; Nowak, Piotr
; Treutiger, Carl Johan
; Gisslén, Magnus
and Elvstam, Olof
LU
- organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Adolescent, Anti-HIV Agents/pharmacology, CD4 Lymphocyte Count, Female, HIV Infections/drug therapy, HIV-1, Humans, Male, Sweden/epidemiology, Viral Load, Viremia/drug therapy
- in
- PLoS ONE
- volume
- 17
- issue
- 5
- article number
- e0268540
- pages
- 11 pages
- publisher
- Public Library of Science (PLoS)
- external identifiers
-
- pmid:35580115
- scopus:85130110786
- ISSN
- 1932-6203
- DOI
- 10.1371/journal.pone.0268540
- language
- English
- LU publication?
- yes
- id
- 83046b27-0414-48b5-a039-bc020ced822a
- date added to LUP
- 2022-06-21 10:15:47
- date last changed
- 2025-11-17 00:12:36
@article{83046b27-0414-48b5-a039-bc020ced822a,
abstract = {{<p>OBJECTIVE: Low-level viraemia (LLV) occurs in some people with HIV (PWH) receiving antiretroviral therapy (ART) and has been linked to inferior treatment outcomes. We investigated factors associated with LLV in a nationwide cohort of Swedish PWH starting ART.</p><p>METHODS: Participants were identified from the InfCareHIV register, with the following inclusion criteria: ART initiation 2006-2017, age >15 years, ≥4 viral load (VL) results available and no documented treatment interruptions or virologic failure (≥2 consecutive VL ≥200 copies/ml) during follow-up. Starting from 6 months after ART initiation, participants were followed for 24 months and categorised as viral suppression (VS; VL <50 copies/ml) or LLV (≥2 consecutive VL 50-199 copies/ml). We analysed the association between the following factors and LLV using multivariable logistic regression: sex, age, pre-ART VL and CD4 count, ART regimen, country of birth, HIV-1 subtype and transmission category.</p><p>RESULTS: Among 3383 participants, 3132 (92.6%) had VS and 251 (7.4%) had LLV. In univariable analyses, factors associated with LLV were male sex, higher age, lower pre-ART CD4 count, higher pre-ART VL and ART regimen. After adjustment, the following factors were associated with LLV (adjusted odds ratio; 95% confidence interval): male sex (1.6; 1.1-2.3), higher pre-ART VL (2.7; 2.2-3.3), pre-ART CD4 count <200 cells/μl (1.6; 1.2-2.2), protease inhibitor (PI)-based regimen (1.5; 1.1-2.1), non-standard ART (2.4; 1.0-5.5) and injecting drug use (2.0; 1.1-3.7).</p><p>CONCLUSION: Among Swedish PWH, LLV during ART was associated with markers of HIV disease severity before starting ART, male sex, injecting drug use and use of PI-based or non-standard ART regimens.</p>}},
author = {{Brattgård, Hanna and Björkman, Per and Nowak, Piotr and Treutiger, Carl Johan and Gisslén, Magnus and Elvstam, Olof}},
issn = {{1932-6203}},
keywords = {{Adolescent; Anti-HIV Agents/pharmacology; CD4 Lymphocyte Count; Female; HIV Infections/drug therapy; HIV-1; Humans; Male; Sweden/epidemiology; Viral Load; Viremia/drug therapy}},
language = {{eng}},
number = {{5}},
publisher = {{Public Library of Science (PLoS)}},
series = {{PLoS ONE}},
title = {{Factors associated with low-level viraemia in people with HIV starting antiretroviral therapy : A Swedish observational study}},
url = {{http://dx.doi.org/10.1371/journal.pone.0268540}},
doi = {{10.1371/journal.pone.0268540}},
volume = {{17}},
year = {{2022}},
}