Low-Level Viremia in People Living with HIV: A Retrospective Cohort Study
VIRUSES, vol.18, pp.611, 2026 (SCI-Expanded, Scopus)
- Publication Type: Article / Article
- Volume: 18
- Publication Date: 2026
- Doi Number: 10.3390/v18060611
- Journal Name: VIRUSES
- Journal Indexes: Scopus, Science Citation Index Expanded (SCI-EXPANDED), BIOSIS, EMBASE, MEDLINE, Directory of Open Access Journals
- Page Numbers: pp.611
- Open Archive Collection: AVESIS Open Access Collection
- Bursa Uludag University Affiliated: Yes
Abstract
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.