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Background  Low level viremia (LLV) often occurs during antiretroviral therapy (ART) against HIV-1. However, whether LLV increases the risk of virologic failure (VF) is controversial because of the non-uniform definitions of LLV and VF.    Methods  A long-term first line regimen ART cohort from 2002 to 2018 from Shenyang, northeast China, was retrospectively studied. All participants were followed up every 3 to 6 months to evaluate the treatment effect. The high-risk LLV subgroups leading to VF (with strict standards) were explored with Cox proportional hazards model and linear mixed-effect model. The association factors of high-risk LLV were further explored using multivariate logistic regression analyses.    Results  A total of 2155 HIV-1 infected participants were included; of these, 38.7% showed LLV. Both high level LLV (HLLV) and any other level LLV coupled with high level blip (HLB) showed higher risk of VF (hazards ratios, HR HLLV  = 5.93, and HR HLB  = 2.84,  p  <  0.05 respectively). Moreover, HR increased with prolonged duration of LLV. Independent factors associated with high-risk LLV included the zenith baseline viral load (VL) above 6 log copies/ml (aOR = 3.49,  p  = 0.002), nadir baseline CD4 + T cell counts below 200 cells/mm 3  (aOR = 1.78,  p  = 0.011), Manchu (aOR = 2.03,  p  = 0.003), ART over 60 months (aOR = 1.81,  p  = 0.004), AZT + 3TC + NVP (aOR = 2.26,  p  <  0.001) or DDI-based regimen (aOR = 9.96,  p  = 0.002), and subtype B′ infection (aOR = 8.22,  p  = 0.001).    Conclusions  In case of VF with strict standards, high-risk LLV leading to VF includes VL above 400 copies/ml, occurring at least once. Serious laboratory indicators or advanced stage of infection, long term ART and subtype B′ infection might also predict the occurrence of high-risk LLV.

bmc infectious diseases

Factors associated with high-risk low-level viremia leading to virologic failure: 16-year retrospective study of a Chinese antiretroviral therapy cohort