Low Level Viremia Is Associated With Serious non-AIDS Events in People With HIV

Area of Science:

• Infectious Diseases
• Virology
• Clinical Medicine

Background:

• The clinical significance of low-level viremia (LLV) in individuals with HIV remains incompletely understood.
• Previous research has not definitively established the link between LLV and adverse health outcomes.

Purpose of the Study:

• To investigate the association between low-level viremia (LLV) and the incidence of serious non-AIDS events (SNAEs) in people with HIV.
• To quantify the risk of SNAEs in relation to different levels of viremia during antiretroviral therapy.

Main Methods:

• Analysis of data from the US Military HIV Natural History Study, including participants who initiated antiretroviral therapy after 1996.
• Categorization of viral loads (VLs) into virologic suppression (VS; <50 copies/mL), low-level viremia (LLV; 51-199 copies/mL), higher level of low-level viremia (HLLV; 200-999 copies/mL), and virologic failure (VF; ≥200 copies/mL on 2+ occasions or ≥1000 copies/mL on one occasion).
• Use of Cox proportional hazards models to assess the association between LLV categories and SNAEs, with adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) reported.

Main Results:

• Among 2528 participants followed for a median of 11 years, 439 (17.4%) experienced SNAEs.
• LLV and HLLV were the highest recorded viremia strata in 8.5% and 4.6% of participants, respectively.
• Compared to virologic suppression (VS), SNAEs were significantly associated with LLV (aHR=1.3, 95% CI [1.2-1.4]), HLLV (aHR=1.6, 95% CI [1.5-1.7]), and virologic failure (aHR=1.7, 95% CI [1.7-1.8]).

Conclusions:

• Low-level viremia (LLV) is significantly associated with an increased risk of serious non-AIDS events (SNAEs) in people with HIV.
• These findings underscore the importance of maintaining virologic suppression and suggest that LLV warrants further investigation as a potential risk factor for morbidity.