Infectious Disease Clinic, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy.
Microbiology and Diagnostic Immunology, Bambino Gesu Paediatric Hospital, Roma, Italy.
Sex Transm Infect. 2024 Oct 17;100(7):460-468. doi: 10.1136/sextrans-2024-056198.
HIV-1 management has advanced significantly with antiretroviral therapy (ART), yet challenges persist, including low-level HIV-1 viraemia (LLV). LLV presents a complex scenario, with varied definitions in the literature, reflecting uncertainties in its clinical interpretation. Questions arise regarding the underlying mechanisms of LLV, whether it signifies ongoing viral replication or stems from other factors. This study aimed to systematically review strategies for LLV management, providing insights into optimal clinical approaches.
MEDLINE, EMBASE, Cochrane Library, Web of Science and Canadian Agency for Drugs and Technologies in Health were searched for relevant literature on LLV management. We included studies published between 2004 and 2024, assessing interventions such as ART modification, genotypic resistance testing, adherence assessment, performing therapeutic drug monitoring, testing for chronic coinfections and assessing the viral reservoir via HIV DNA quantification. Meta-analyses were conducted where feasible.
The systematic review identified 48 eligible records. Findings indicated limited evidence supporting the effectiveness of ART regimen modification in achieving virological suppression among individuals with LLV. However, studies assessing genotypic resistance testing revealed a significant association between resistance-associated mutations and virological suppression during LLV. Adherence to ART emerged as a critical determinant of treatment efficacy, with interventions showing promise in achieving viral suppression. The clinical utility of therapeutic drug monitoring in managing LLV remained inconclusive. Gaps in the literature were identified regarding follow-up scheduling, managing concurrent chronic infections and assessing inflammatory markers in LLV management.
While ART modification may not consistently achieve virological suppression, genotypic resistance testing may offer insights into treatment outcomes. Adherence to ART emerged as a crucial factor, necessitating tailored interventions. However, further research is needed to elucidate the clinical utility of therapeutic drug monitoring and other management strategies. The study highlights the importance of ongoing research to refine therapeutic approaches and improve patient outcomes in LLV management.
CRD42024511492.
随着抗逆转录病毒疗法（ART）的发展，HIV-1 的管理取得了重大进展，但仍存在挑战，包括低水平 HIV-1 病毒血症（LLV）。LLV 呈现出复杂的情况，文献中有不同的定义，反映了其临床解释的不确定性。人们对 LLV 的潜在机制、它是否表示持续的病毒复制或源于其他因素产生疑问。本研究旨在系统地综述 LLV 管理策略，为最佳临床方法提供见解。
在 MEDLINE、EMBASE、Cochrane 图书馆、Web of Science 和加拿大药物和技术评估机构中搜索有关 LLV 管理的相关文献。我们纳入了 2004 年至 2024 年期间发表的研究，评估了包括改变 ART 方案、基因耐药性测试、评估依从性、进行治疗药物监测、检测慢性合并感染以及通过 HIV DNA 定量评估病毒库在内的干预措施。在可行的情况下进行了荟萃分析。
系统综述确定了 48 项符合条件的记录。研究结果表明，ART 方案修改在实现 LLV 个体病毒学抑制方面的有效性证据有限。然而，评估基因耐药性测试的研究表明，耐药相关突变与 LLV 期间的病毒学抑制之间存在显著关联。ART 依从性是治疗效果的关键决定因素，干预措施在实现病毒抑制方面显示出前景。治疗药物监测在管理 LLV 中的临床应用仍不确定。文献中存在关于随访安排、管理同时存在的慢性感染和评估 LLV 管理中的炎症标志物的空白。
虽然 ART 方案修改不一定能始终实现病毒学抑制，但基因耐药性测试可能提供有关治疗结果的信息。ART 依从性是一个关键因素，需要进行有针对性的干预。然而，需要进一步研究阐明治疗药物监测和其他管理策略的临床应用。本研究强调了开展研究的重要性，以完善 LLV 管理中的治疗方法并改善患者结局。
CRD42024511492。
