Association of low‐level viremia with mortality among people living with HIV on antiretroviral therapy in Dehong, Southwest China: A retrospective cohort study

Abstract

Objectives: To investigate the association of low-level viremia (LLV) with mortality among people living with HIV (PLHIV) on antiretroviral therapy (ART) in Dehong, Southwest China. Methods:We analysed data collected from a cohort of PLHIV on ART in Dehong. PLHIV were enrolled in this cohort after they started ART, with viral load (VL) tested once a year afterwards. Each VL level was then categorized into one of the four groups: <50, 50-199, 200-999 and ≥1000 copies/ml. VL levels of 50-199 and 200-999 copies/ml were defined as LLV. The VL level for each participant was re-categorized and fitted into an extended Cox regression model as a time-varying covariate to examine the associations of VL level with all-cause and AIDS-related deaths. Results: Among the included 7273 of 8762 PLHIV in this study, median age (interquartile range, IQR) was 36 (30-43) years and 59.9% were male. The patients were followed up for a median duration (IQR) of 6.2 (4.3-8.2) years.Compared with VL <50 copies/ml, LLV 200-999 copies/ml (adjusted hazard ratio [aHR] and 95% confidence interval [95% CI]: 1.56 [1.04, 2.32]) were associated with elevated risk of all-cause mortality and LLV50-199 (aHR [95% CI]: 1.00 [0.68, 1.45]) were not. Similarly, only LLV200-999 copies/ml (aHR [95% CI]: 2.37 [1.36, 4.14]) corresponded to higher risk of AIDS-related mortality.Conclusions: This study suggests that PLHIV on ART may have elevated death risks even though the viremia is suppressed at a low level. Interventions targeting PLHIV with LLV should be developed to reduce their mortality.Hailiang Yu, Yuecheng Yang and Dongdong Cao are contributed equally to this article.

Outcomes of severely ill patients with AIDS treated with efavirenz or dolutegravir: a multicenter, observational study

“…Although faster viral suppression is a characteristic of integrase inhibitor-based treatment, there is no previous evidence showing a clear immunological benefit of it. However, recent studies showed that low-level viremia as well as viremic time are predictive of mortality in patients with HIV ( 14 , 15 ). Our findings suggest that severely ill patients can benefit from faster virological suppression.…”

Clinical significance and management of low‐level HIV viremia in the era of integrase strand transfer inhibitors

“…Currently, data reported on the impact of LLV on the clinical progression of HIV patients are rather inconsistent. In the cohort study by Bernal et al, PLWH with LLV 200–499 copies/mL were strongly associated with VF and AIDS events/death but not with any serious nADEs [32]. Although some previous studies have noted that PLWH with LLV are not at higher risk for death and AIDS events, others found that LLV is associated with higher AIDS events/death [6, 8].…”

“…Although some previous studies have noted that PLWH with LLV are not at higher risk for death and AIDS events, others found that LLV is associated with higher AIDS events/death [6, 8]. A retrospective cohort study in Dehong, Southwest China found that LLV 200–999 copies/mL was associated with an elevated risk of all‐cause mortality compared with VL <50 copies/mL and that LLV 200–999 copies/mL corresponded to a higher risk of AIDS‐related mortality [32].…”