NHC Key Laboratory of AIDS Immunology (China Medical University), Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China.
National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China.
BMC Infect Dis. 2020 Feb 17;20(1):147. doi: 10.1186/s12879-020-4837-y.
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.
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.
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 = 5.93, and HR = 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 (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).
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.
在针对 HIV-1 的抗逆转录病毒治疗（ART）期间，经常会出现低水平病毒血症（LLV）。然而，由于 LLV 和病毒学失败（VF）的定义不统一，因此 LLV 是否会增加 VF 的风险存在争议。
回顾性研究了来自中国东北沈阳的 2002 年至 2018 年的长期一线方案 ART 队列。所有参与者每 3 至 6 个月接受一次随访，以评估治疗效果。使用 Cox 比例风险模型和线性混合效应模型探讨了导致 VF 的高风险 LLV 亚组（采用严格标准）。使用多变量逻辑回归分析进一步探讨了高风险 LLV 的相关因素。
共纳入 2155 名 HIV-1 感染参与者；其中 38.7% 表现出 LLV。高水平 LLV（HLLV）和任何其他水平 LLV 伴有高水平病毒载量（VL）波动（HLB）均显示出更高的 VF 风险（风险比，HR=5.93 和 HR=2.84，p<0.05）。此外，HR 随 LLV 持续时间的延长而增加。与高风险 LLV 相关的独立因素包括：基线病毒载量（VL）超过 6 log 拷贝/ml（优势比，aOR=3.49，p=0.002）、最低点 CD4+T 细胞计数低于 200 个细胞/mm（aOR=1.78，p=0.011）、满族（aOR=2.03，p=0.003）、ART 超过 60 个月（aOR=1.81，p=0.004）、AZT+3TC+NVP（aOR=2.26，p<0.001）或 DDI 为基础的方案（aOR=9.96，p=0.002）和 B' 亚型感染（aOR=8.22，p=0.001）。
在严格标准下出现 VF 时，导致 VF 的高风险 LLV 包括至少一次发生的 VL 超过 400 拷贝/ml。严重的实验室指标或感染的晚期、长期 ART 和 B' 亚型感染也可能预测高风险 LLV 的发生。
