A plea for new guidance and research: Low-level viremia in persons living with HIV

HIV is a single-stranded RNA virus that can be transmitted through sexual intercourse, during pregnancy from mother to child, as a result of hypodermic needle use, or through infected blood transfusions.  The World Health Organization (WHO) estimates there were 39.9 million persons living with HIV (PLWH) at the end of 2023. The incidence of HIV and HIV-associated mortality has decreased by 39% and 51%, respectively, since 2010. This progress is partly due to the development of antiretroviral (ARV) medication that allows for HIV RNA suppression (undetectable HIV levels). Combination ARVs, or antiretroviral therapy (ART), have been shown to significantly improve survival, reduce HIV RNA levels, and reduce ART resistance to HIV in PLWH. While receiving ART, a phenomenon can occur where patients can present with a low level of virus that is detectable but still clinically suppressed, known as low-level viremia (LLV). Currently, there is minimal guidance from contemporary HIV guidelines from the US Department of Health and Human Services (DHHS), the European AIDS Clinical Society (EACS), and the WHO on how to manage LLV.

An article in Contagion Live reviews the clinical significance of patients with LLV and the current literature surrounding the management of LLV in PLWH.