Low-Level Viremia in People Living with HIV: A Retrospective Cohort Study

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Önal U., Özdemir E., Öncül Ş., Öztürk Belik H., Kazak E., Heper Y., ...Daha Fazla

VIRUSES, cilt.18, ss.611, 2026 (SCI-Expanded, Scopus)

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 18
  • Basım Tarihi: 2026
  • Doi Numarası: 10.3390/v18060611
  • Dergi Adı: VIRUSES
  • Derginin Tarandığı İndeksler: Scopus, Science Citation Index Expanded (SCI-EXPANDED), BIOSIS, EMBASE, MEDLINE, Directory of Open Access Journals
  • Sayfa Sayıları: ss.611
  • Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
  • Bursa Uludağ Üniversitesi Adresli: Evet

Özet

Background: Durable virological suppression is achieved in the majority of people living
with HIV (PLWH) receiving contemporary antiretroviral therapy (ART). However, a subset
of patients experience persistent low-level viremia (LLV), the clinical relevance and underlying
determinants of which remain incompletely understood. Methods: Adult PLWH
followed between 1 January 2005 and 31 December 2025 were retrospectively evaluated.
LLV was defined as detectable HIV-1 RNA < 200 copies/mL on at least two consecutive
measurements during follow-up in individuals receiving ART for at least 6 months. Patients
with sustained virological suppression served as controls. Propensity score matching (1:1)
was performed using variables associated with LLV in univariate analyses. Multivariable logistic
regression analysis was applied to identify factors independently associated with LLV,
and a p value < 0.05 was considered statistically significant. Results: Among 880 PLWH,
45 patients with LLV and 113 virologically suppressed controls were included. LLV was
associated with lower baseline CD4+ T-cell counts, higher baseline HIV-1 RNA levels,
delayed virological suppression at weeks 8 and 24, increased frequency of AIDS-defining
illnesses and a higher prevalence of metabolic comorbidities, including hypertension, diabetes
mellitus or dyslipidemia in univariate analysis. After propensity score matching,
32 patients remained in each group, with no clear association between low-level viremia
and antiretroviral regimen class. Multivariable regression analysis showed baseline CD4+
T-cell count < 200 cells/μL, and the presence of ≥1 metabolic comorbidity (hypertension,
diabetes mellitus or dyslipidemia) remained independently associated with LLV.
Conclusions: Our findings suggest that LLV is associated with host-related factors rather
than antiretroviral regimen failure. The coexistence of immunological impairment and
metabolic comorbidities in patients with LLV underscores the importance of comprehensive
clinical evaluation.