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Low-level HIV viraemia during antiretroviral therapy : Longitudinal patterns and predictors of viral suppression

Elén, S ; Björkman, P LU orcid ; Zazzi, M ; Böhm, M ; Bernal, E ; Sönnerborg, A and Elvstam, O LU orcid (2024) In HIV Medicine 25(1). p.107-116
Abstract

OBJECTIVES: Our objective was to characterize longitudinal patterns of viraemia and factors associated with viral suppression in people with HIV and low-level viraemia (LLV) during antiretroviral therapy (ART).

METHODS: We included people with HIV in the EuResist Integrated Database with LLV following ART initiation after 2005. LLV was defined as two or more consecutive viral load (VL) measurements of 51-199 copies/mL 30-365 days apart after >12 months of ART. Viraemia patterns were analyzed over 24 months. Factors associated with viral suppression at 12 months after LLV episodes were identified using univariable and multivariable logistic regression.

RESULTS: Of 25 113 people with HIV, 2474 (9.9%) had LLV. Among 1387... (More)

OBJECTIVES: Our objective was to characterize longitudinal patterns of viraemia and factors associated with viral suppression in people with HIV and low-level viraemia (LLV) during antiretroviral therapy (ART).

METHODS: We included people with HIV in the EuResist Integrated Database with LLV following ART initiation after 2005. LLV was defined as two or more consecutive viral load (VL) measurements of 51-199 copies/mL 30-365 days apart after >12 months of ART. Viraemia patterns were analyzed over 24 months. Factors associated with viral suppression at 12 months after LLV episodes were identified using univariable and multivariable logistic regression.

RESULTS: Of 25 113 people with HIV, 2474 (9.9%) had LLV. Among 1387 participants with 24 months of follow-up after LLV, 406 (29%) had persistent suppression, 669 (48%) had transient viraemic episodes, 29 (2%) had persistent LLV, and 283 (20%) had virological failure. Following LLV episodes, the proportion with detectable viraemia declined (p for trend <0.001 and 0.034, in the first and second year, respectively). At 12 months, 68% had undetectable VL, which was associated with suppression before LLV (adjusted odds ratio [aOR] 1.7; 95% confidence interval [CI] 1.2-2.4) and ART modification after LLV (aOR 1.6; 95% CI 1.0-2.4). The following factors were negatively associated with undetectable VL at 12 months: higher VL during LLV (aOR 0.57 per log
10 copies/mL; 95% CI 0.37-0.89), injecting drug use (aOR 0.67; 95% CI 0.47-0.96), and regimens with protease inhibitors (aOR 0.65; 95% CI 0.49-0.87) or combined anchor drugs (aOR 0.52; 95% CI 0.32-0.85).

CONCLUSION: Most people with LLV did not experience sustained viral suppression during 24-month follow-up, supporting the association between LLV and inferior treatment outcome.

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author
; ; ; ; ; and
author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
HIV Medicine
volume
25
issue
1
pages
107 - 116
publisher
Wiley-Blackwell
external identifiers
  • scopus:85171385288
  • pmid:37721192
ISSN
1468-1293
DOI
10.1111/hiv.13541
language
English
LU publication?
yes
additional info
© 2023 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.
id
913a41a0-1899-408d-95df-45db59f6c87a
date added to LUP
2023-09-21 08:40:14
date last changed
2024-04-19 02:32:10
@article{913a41a0-1899-408d-95df-45db59f6c87a,
  abstract     = {{<p>OBJECTIVES: Our objective was to characterize longitudinal patterns of viraemia and factors associated with viral suppression in people with HIV and low-level viraemia (LLV) during antiretroviral therapy (ART).</p><p>METHODS: We included people with HIV in the EuResist Integrated Database with LLV following ART initiation after 2005. LLV was defined as two or more consecutive viral load (VL) measurements of 51-199 copies/mL 30-365 days apart after &gt;12 months of ART. Viraemia patterns were analyzed over 24 months. Factors associated with viral suppression at 12 months after LLV episodes were identified using univariable and multivariable logistic regression.</p><p>RESULTS: Of 25 113 people with HIV, 2474 (9.9%) had LLV. Among 1387 participants with 24 months of follow-up after LLV, 406 (29%) had persistent suppression, 669 (48%) had transient viraemic episodes, 29 (2%) had persistent LLV, and 283 (20%) had virological failure. Following LLV episodes, the proportion with detectable viraemia declined (p for trend &lt;0.001 and 0.034, in the first and second year, respectively). At 12 months, 68% had undetectable VL, which was associated with suppression before LLV (adjusted odds ratio [aOR] 1.7; 95% confidence interval [CI] 1.2-2.4) and ART modification after LLV (aOR 1.6; 95% CI 1.0-2.4). The following factors were negatively associated with undetectable VL at 12 months: higher VL during LLV (aOR 0.57 per log<br>
 10 copies/mL; 95% CI 0.37-0.89), injecting drug use (aOR 0.67; 95% CI 0.47-0.96), and regimens with protease inhibitors (aOR 0.65; 95% CI 0.49-0.87) or combined anchor drugs (aOR 0.52; 95% CI 0.32-0.85).<br>
 </p><p>CONCLUSION: Most people with LLV did not experience sustained viral suppression during 24-month follow-up, supporting the association between LLV and inferior treatment outcome.</p>}},
  author       = {{Elén, S and Björkman, P and Zazzi, M and Böhm, M and Bernal, E and Sönnerborg, A and Elvstam, O}},
  issn         = {{1468-1293}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{107--116}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{HIV Medicine}},
  title        = {{Low-level HIV viraemia during antiretroviral therapy : Longitudinal patterns and predictors of viral suppression}},
  url          = {{http://dx.doi.org/10.1111/hiv.13541}},
  doi          = {{10.1111/hiv.13541}},
  volume       = {{25}},
  year         = {{2024}},
}