Clinical Relevance of Human Immunodeficiency Virus Low-level Viremia in the Dolutegravir era: Data From the Viral Load Cohort North-East Lesotho (VICONEL)

Abstract

Background HIV low-level viremia (LLV) is associated with subsequent treatment failure at least with non-nucleoside reverse transcriptase inhibitor (NNRTI)-containing antiretroviral therapy (ART). Data on implications of LLV occurring under dolutegravir, which has largely replaced NNRTIs in Africa, are, however, scarce. Methods We included adult persons with HIV in Lesotho who had ≥2 viral loads (VLs) taken after ≥6 months of NNRTI- or dolutegravir-based ART. Within VL pairs, we assessed the association of viral suppression (<50 copies/mL), low- and high-range LLV (50-199 and 200-999 copies/mL, respectively) with virological failure (≥1000 copies/mL) using a mixed-effects regression model. Participants could contribute VLs to the NNRTI and the dolutegravir group. Results Among 18,550 participants, 12,216 (65.9%) were female and median age at first VL included was 41.2 years (interquartile range 33.4-51.5). In both groups, compared to a suppressed VL, odds of subsequent virological failure were higher for low-range LLV (NNRTI: adjusted odds ratio (aOR); 95% confidence interval (CI): 1.9; 1.4-2.4 and dolutegravir: 2.1; 1.3-3.6) and high-range LLV (aOR; 95% CI: 4.2; 3.1-5.7 and 4.4; 2.4-7.9). Conclusion In the dolutegravir era, LLV remains associated with virological failure, endorsing the need for close clinical and laboratory monitoring of persons with a VL ≥50 copies/mL.