An Jing, Lao Yunfei, Tang Songyuan, Lou Jincheng, Li Tianshu, Dong Xingqi
AIDS Clinical Management Office, Yunnan Provincial Infectious Disease Hospital, Kunming, China.
Public Health School, Kunming Medical University, Kunming, China.
Front Med (Lausanne). 2022 Jul 4;9:939261. doi: 10.3389/fmed.2022.939261. eCollection 2022.
HIV viral load (VL) is an important indicator to monitor treatment response in antiretroviral therapy (ART). Patients on ART may experience viral blips, with low-level elevations of VL between 50 and 999 copies/mL known as low-level viraemia (LLV), but not reaching the threshold for virological failure (≥1,000 copies/mL) defined by WHO guidelines. The objective was to investigate the long-term impact of LLV on virological failure.
We analyzed adults who were ART naïve at baseline. LLV was defined as having an VL of 51-999 copies/mL at least once. The subjects with LLV were grouped into three categories: 51-199, 200-399, and 400-999 copies/mL. Patients with multiple episodes of LLV were classified based on the highest VL result. The subjects with LLV were also grouped by the frequency of LLV, i.e., a single episode, two consecutive episodes, two intermittent episodes, more than two consecutive episodes, and more than two intermittent episodes. Multivariable Cox models were used to predict the association of LLV with virological failure.
A total of 93,944 subjects were included. The median number of VL tests performed was 3. There were 21,203 LLV cases, with an overall incidence of 22.6%. Most of the LLV cases were found in subjects with LVs of 50-199 copies/mL, followed by 400-999 and 200-399 copies/mL. Most of the LLV cases experienced single episodes, and the numbers of LLV with two consecutive episodes, two intermittent episodes, more than two consecutive episodes and more than two intermittent episodes were decreased successively. The risk factors associated with virological failure include: intermediate-level (200-399 copies/mL) and high-level (400-999 copies/mL) LLV, single episodes of LLV and two or more than two consecutive episodes of LLV, which may put the subjects at a 1.28-2.26-fold higher risk for virological failure.
Strengthened immediate medical attention should be placed on patients with VL of 200-999 copies/mL. The patients having experienced LLV once should be targeted for case management and repeat VL testing within 24 weeks to determine persistent LLV and monitor virological failure.
HIV病毒载量（VL）是监测抗逆转录病毒疗法（ART）治疗反应的重要指标。接受ART治疗的患者可能会出现病毒波动，VL在50至999拷贝/毫升之间的低水平升高被称为低水平病毒血症（LLV），但未达到世界卫生组织指南定义的病毒学失败阈值（≥1000拷贝/毫升）。目的是研究LLV对病毒学失败的长期影响。
我们分析了基线时未接受过ART治疗的成年人。LLV定义为VL至少有一次在51 - 999拷贝/毫升。LLV患者分为三类：51 - 199、200 - 399和400 - 999拷贝/毫升。多次出现LLV的患者根据最高VL结果进行分类。LLV患者还按LLV发生频率分组，即单次发作、连续两次发作、两次间歇性发作、连续两次以上发作和间歇性发作两次以上。使用多变量Cox模型预测LLV与病毒学失败的关联。
共纳入93944名受试者。VL检测的中位数为3次。有21203例LLV病例，总发生率为22.6%。大多数LLV病例出现在VL为50 - 199拷贝/毫升的受试者中，其次是400 - 999和200 - 399拷贝/毫升。大多数LLV病例为单次发作，连续两次发作、两次间歇性发作、连续两次以上发作和间歇性发作两次以上的LLV病例数依次减少。与病毒学失败相关的危险因素包括：中级（200 - 399拷贝/毫升）和高级（400 - 999拷贝/毫升）LLV、单次LLV发作以及连续两次或两次以上LLV发作，这可能使受试者发生病毒学失败的风险高1.28 - 2.26倍。
应加强对VL为200 - 999拷贝/毫升患者的即时医疗关注。对曾经历过LLV的患者应进行病例管理，并在24周内重复进行VL检测，以确定持续性LLV并监测病毒学失败情况。
