Factors Influencing Low-level Viremia In HIV Patients And Its Clinical Significance

ObjectiveThis study aimed to explore the factors influencing the occurrence of low-level viremia(LLV)in HIV-infected patients during long-term antiretroviral therapy(ART)and to assess the impact of different levels and frequencies of LLV on the clinical outcomes of these patients.The findings aim to provide a theoretical basis for the management and treatment of HIV LLV patients by clinicians.MethodsRetrospective data were collected from the VCT outpatient system database of the Shanghai Public Health Clinical Center,encompassing demographic characteristics and clinical information of HIV-infected individuals aged 18 years and above who received regular follow-up between January 1,2011,and December 31,2015.The study endpoint for data collection was December 31,2020.The study population was divided into two groups:persistent viral suppression and LLV.Statistical analysis was performed using SPSS 26.0 software to analyze variables such as age,gender,baseline viral load(VL),baseline CD4~+T lymphocyte count(CD4),compliance,and changes in medication during follow-up.Univariate analysis employed theχ~2or Fisher’s exact test,while factors showing statistical significance were included in logistic regression for multivariate analysis..Results1.A total of 3787 HIV-infected patients were included in this study.The median age of the patients was 34 years(27,46),with 3515(92.81%)being male.Good compliance was observed in 3726(98.39%)patients,and 86.69%(3283/3787)of the patients initiated ART with Efavirenz+2 nucleoside reverse transcriptase inhibitors(EFV+2NRTI).2.During the follow-up period,LLV was observed in 15.47%(586/3787)of the cases.LLV patients exhibited plasma VL in the ranges of 50-200 copies/m L,201-400copies/m L,and 401-999 copies/m L,accounting for 12.41%(470 individuals),1.29%(49 individuals),and 1.08%(41 individuals),respectively.3.Factors associated with LLV occurrence,compared to the sustained viral suppression group,included age 50 years and above(adjusted odds ratio[a OR]:1.28,95%confidence interval[CI]:1.03-1.59,P=0.027),poorer adherence(a OR:8.33,95%CI:4.82-14.40,P=0.001),baseline CD4~+T lymphocyte count≥200 cells/mm3(a OR:0.61,95%CI:0.50-0.75,P=0.001),baseline VL≥1×105 copies/m L(odds ratio[OR]:3.68,95%CI:2.09-6.47,P=0.001),and initiation of ART regimen containing Protease Inhibitor(PIs)(a OR:1.89,95%CI:1.20-2.98,P=0.006).Gender,marital status,route of HIV infection,and time interval between diagnosis and ART showed no significant differences between the two groups.4.Among LLV cases,59.73%(350/586)experienced LLV within the first year after starting ART.Additionally,LLV with a plasma VL of 200 copies/m L and above may be a risk factor for virologic failure(VF)development.5.The effect of different frequencies of LLV during antiviral therapy on subsequent virological failure did not show statistically significant differences(P=0.472).Conclusions1.The incidence of LLV in HIV-infected patients undergoing standardized antiretroviral therapy in Shanghai during the follow-up period of this study was15.47%(586/3787).2.LLV occurrence may be associated with age,baseline VL,adherence,baseline CD4~+T lymphocyte count,and initiation of ART regimen.3.LLV appeared in 59.73%of the cases in the LLV group within the first year after starting ART.4.LLV with a plasma VL of 200 copies/m L and above may be a risk factor for VF development among LLV cases.