Persistent viral load between 150 and 200 associated with later virologic failure in Swiss study

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Persistently high levels of low-level viremia, defined as 150-200 copies/mL, are associated with later virologic failure in people on antiretroviral therapy and should be closely monitored, findings from a Swiss study suggested.

About This Study

HIV-1 low-level viremia predicts viral failure in participants on antiretroviral therapy in the Swiss HIV Cohort Study” was published online on Nov. 21, 2024, in Clinical Infectious Diseases. The lead author is Caroline Lanz of the Department of Infectious Diseases and Hospital Epidemiology at University Hospital Zurich, Switzerland.

Key Research Findings

Based on longitudinal data from the Swiss HIV Cohort Study, this prospective cohort study evaluated viral load developments in 8,132 participants without viral failure six months after treatment start. Between 1999 and 2023, participants contributed 49,579 person-years during a median 4.7 years of follow-up each. Seventy-six percent of participants were men and 74% of participants were white.

Viral loads <50 copies/mL were considered undetectable, while HIV RNA between that level and 200 copies/mL was defined as low-level viremia, even if the viral load rose only briefly (“blip”). Any measurements ≥200 copies/mL were categorized as viral failures. The 50-200 copies/mL range was trisected into low (50-99), intermediate (100-149), and high (150-200) low-level viremia.

Seventy-one percent of participants were persistently virally suppressed and 87% of all participants had at most a blip. Virologic failure occurred in 8% of participants and was strongly associated with previous high low-level viremia, with an even stronger association when viral blips were not included. Other risk factors for viral failure were a treatment regimen of unboosted protease inhibitors and nucleoside reverse transcriptase inhibitors, low CD4 cell counts, and a high viral load before starting treatment.

Discussion Highlights and Implications for Practice

Study limitations reported included patient-reported adherence, more sensitive viral load detection in later time periods, and changes in treatment guidelines over time.

The researchers concluded that persistent low-level viremia, especially in the 150-200 copies/mL range, needs to be monitored and treatment regimen modifications should be considered to prevent virologic failure. They also called for further research into the mechanisms behind the observed association.

By Barbara Jungwirth

 

Source : TheBodyPro

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