Consequences of Low-level Viremia Among Women with HIV in the United States

Overview

Journal AIDS

Specialty Infectious Diseases

Date 2024 Aug 7

PMID 39110550

Authors

Amalia Aldredge

C Christina Mehta

Cecile D Lahiri

Michael F Schneider

Maria L Alcaide

Kathryn Anastos

Michael Plankey

Audrey L French

Michelle Floris-Moore

Phyllis C Tien

Jodie Dionne

Jack DeHovitz

Lauren F Collins

Anandi N Sheth

Affiliations

Soon will be listed here.

Abstract

Objective: Investigate the outcomes of women with HIV (WWH) with low-level viremia (LLV).

Design: The prevalence of LLV and potential clinical sequelae, such as virologic failure and non-AIDS comorbidity (NACM) development, are poorly characterized among WWH.

Methods: We analyzed data from the Women's Interagency HIV Study among WWH enrolled from 2003 to 2020 who reported antiretroviral therapy use at least 1 year followed by an HIV-1 viral load less than 200 copies/ml. Consecutive viral load measurements from four semi-annual visits were used to categorize women at baseline as having: virologic suppression (all viral load undetectable), intermittent LLV (iLLV; nonconsecutive detectable viral load up to 199 copies/ml), persistent LLV (pLLV; at least two consecutive detectable viral load up to 199 copies/ml), or virologic failure (any viral load ≥200 copies/ml). Adjusted hazard ratios quantified the association of virologic category with time to incident virologic failure and multimorbidity (≥2 of 5 NACM) over 5-year follow-up.

Results: Of 1598 WWH, baseline median age was 47 years, 64% were Black, 21% Hispanic, and median CD4 + cell count was 621 cells/μl. After excluding 275 women (17%) who had virologic failure at baseline, 58, 19, and 6% were categorized as having virologic suppression, iLLV, and pLLV, respectively. Compared with WWH with virologic suppression, the adjusted hazard ratio [aHR; 95% confidence interval (CI)] for incident virologic failure was 1.88 (1.44-2.46) and 2.51 (1.66-3.79) for iLLV and pLLV, respectively; and the aHR for incident multimorbidity was 0.81 (0.54-1.21) and 1.54 (0.88-2.71) for iLLV and pLLV, respectively.

Conclusion: Women with iLLV and pLLV had an increased risk of virologic failure. Women with pLLV had a trend towards increased multimorbidity risk.

References

Elvstam O, Marrone G, Medstrand P, Treutiger C, Sonnerborg A, Gisslen M . All-Cause Mortality and Serious Non-AIDS Events in Adults With Low-level Human Immunodeficiency Virus Viremia During Combination Antiretroviral Therapy: Results From a Swedish Nationwide Observational Study. Clin Infect Dis. 2020; 72(12):2079-2086. PMC: 8204776. DOI: 10.1093/cid/ciaa413. View

Geretti A, Smith C, Haberl A, Garcia-Diaz A, Nebbia G, Johnson M . Determinants of virological failure after successful viral load suppression in first-line highly active antiretroviral therapy. Antivir Ther. 2008; 13(7):927-36. View

Ganesan A, Hsieh H, Chu X, Colombo R, Berjohn C, Lalani T . Low Level Viremia Is Associated With Serious non-AIDS Events in People With HIV. Open Forum Infect Dis. 2024; 11(4):ofae147. PMC: 11020230. DOI: 10.1093/ofid/ofae147. View

Crespo-Bermejo C, de Arellano E, Lara-Aguilar V, Valle-Millares D, Gomez-Lus M, Madrid R . Persistent low-Level viremia in persons living with HIV undertreatment: An unresolved status. Virulence. 2021; 12(1):2919-2931. PMC: 8654475. DOI: 10.1080/21505594.2021.2004743. View

Curno M, Rossi S, Hodges-Mameletzis I, Johnston R, Price M, Heidari S . A Systematic Review of the Inclusion (or Exclusion) of Women in HIV Research: From Clinical Studies of Antiretrovirals and Vaccines to Cure Strategies. J Acquir Immune Defic Syndr. 2015; 71(2):181-8. DOI: 10.1097/QAI.0000000000000842. View

Collins L, Palella Jr F, Mehta C, Holloway J, Stosor V, Lake J . Aging-Related Comorbidity Burden Among Women and Men With or At-Risk for HIV in the US, 2008-2019. JAMA Netw Open. 2023; 6(8):e2327584. PMC: 10407688. DOI: 10.1001/jamanetworkopen.2023.27584. View

Miller L, Golin C, Liu H, Hays R, Hua J, Wenger N . No evidence of an association between transient HIV viremia ("Blips") and lower adherence to the antiretroviral medication regimen. J Infect Dis. 2004; 189(8):1487-96. DOI: 10.1086/382895. View

An J, Lao Y, Tang S, Lou J, Li T, Dong X . The Impact of Low-Level Viraemia on Virological Failure-Results From a Multicenter HIV Antiretroviral Therapy Cohort Study in Yunnan, China. Front Med (Lausanne). 2022; 9:939261. PMC: 9289465. DOI: 10.3389/fmed.2022.939261. View

Li J, Gallien S, Ribaudo H, Heisey A, Bangsberg D, Kuritzkes D . Incomplete adherence to antiretroviral therapy is associated with higher levels of residual HIV-1 viremia. AIDS. 2013; 28(2):181-186. PMC: 4193963. DOI: 10.1097/QAD.0000000000000123. View

10.

Chun H, Abutu A, Milligan K, Ehoche A, Shiraishi R, Odafe S . Low-level viraemia among people living with HIV in Nigeria: a retrospective longitudinal cohort study. Lancet Glob Health. 2022; 10(12):e1815-e1824. PMC: 9711923. DOI: 10.1016/S2214-109X(22)00413-2. View

11.

Fleming J, Mathews W, Rutstein R, Aberg J, Somboonwit C, Cheever L . Low-level viremia and virologic failure in persons with HIV infection treated with antiretroviral therapy. AIDS. 2019; 33(13):2005-2012. PMC: 6774874. DOI: 10.1097/QAD.0000000000002306. View

12.

Ostrowski S, Katzenstein T, Pedersen B, Gerstoft J, Ullum H . Residual viraemia in HIV-1-infected patients with plasma viral load <or=20 copies/ml is associated with increased blood levels of soluble immune activation markers. Scand J Immunol. 2008; 68(6):652-60. DOI: 10.1111/j.1365-3083.2008.02184.x. View

13.

Jordan M, Winsett J, Tiro A, Bau V, Berbara R, Rowley C . HIV Drug Resistance Profiles and Clinical Outcomes in Patients with Viremia Maintained at Very Low Levels. World J AIDS. 2015; 3(2):71-78. PMC: 4319662. DOI: 10.4236/wja.2013.32010. View

14.

Hill L, Kenney S, Patel N, Yin J, Abulhosn K, Karim A . Predictors of Post-switch Viremia in People With HIV on Injectable Cabotegravir/Rilpivirine. J Acquir Immune Defic Syndr. 2023; 95(1):90-96. DOI: 10.1097/QAI.0000000000003320. View

15.

Leierer G, Grabmeier-Pfistershammer K, Steuer A, Geit M, Sarcletti M, Haas B . Factors Associated with Low-Level Viraemia and Virological Failure: Results from the Austrian HIV Cohort Study. PLoS One. 2015; 10(11):e0142923. PMC: 4643888. DOI: 10.1371/journal.pone.0142923. View

16.

Bernal E, Gomez J, Jarrin I, Cano A, Munoz A, Alcaraz A . Low-Level Viremia Is Associated With Clinical Progression in HIV-Infected Patients Receiving Antiretroviral Treatment. J Acquir Immune Defic Syndr. 2018; 78(3):329-337. DOI: 10.1097/QAI.0000000000001678. View

17.

Gandhi M, Aweeka F, Greenblatt R, Blaschke T . Sex differences in pharmacokinetics and pharmacodynamics. Annu Rev Pharmacol Toxicol. 2004; 44:499-523. DOI: 10.1146/annurev.pharmtox.44.101802.121453. View

18.

Taiwo B, Gallien S, Aga E, Ribaudo H, Haubrich R, Kuritzkes D . Antiretroviral drug resistance in HIV-1-infected patients experiencing persistent low-level viremia during first-line therapy. J Infect Dis. 2011; 204(4):515-20. PMC: 3203388. DOI: 10.1093/infdis/jir353. View

19.

Joya C, Won S, Schofield C, Lalani T, Maves R, Kronmann K . Persistent Low-level Viremia While on Antiretroviral Therapy Is an Independent Risk Factor for Virologic Failure. Clin Infect Dis. 2019; 69(12):2145-2152. PMC: 6880328. DOI: 10.1093/cid/ciz129. View

20.

Gandhi M, Gandhi R, Stefanescu A, Bosch R, Cyktor J, Horng H . Cumulative Antiretroviral Exposure Measured in Hair Is Not Associated With Measures of HIV Persistence or Inflammation Among Individuals on Suppressive ART. J Infect Dis. 2018; 218(2):234-238. PMC: 6009579. DOI: 10.1093/infdis/jiy011. View