Mbishi Jackline V, Koola Adrian, Ally Haji M, Ayalew Biruk D, Sileshi Rebecca M, Hundisa Muhidin I, Rodoshi Zarin N, Htoo Saw W, Bakari Hafidha M, Ally Zuhura M, Fussi Hassan F, Ludeman Emilie, Lascko Taylor, Buyu Celestine A, Ramadhani Habib O
Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Amity Region High School, Woodbridge, Connecticut, USA.
Ann Med Surg (Lond). 2025 Apr 10;87(6):3777-3785. doi: 10.1097/MS9.0000000000003272. eCollection 2025 Jun.
The World Health Organization (WHO) defined low-level viremia (LLV) as a viral load (VL) of 51-999 copies/mL, and LLV has been associated with an increased risk of virological failure and drug resistance. Limited information is available from low- and mid-income countries (LMICs), which predominantly use WHO guidelines in HIV program monitoring. We estimated pooled prevalence of LLV, non-viral load suppression (VLS), and association between LLV and non-VLS among people living with HIV in LMICs.
In this systematic review and meta-analysis, databases were searched for articles reporting the association between LLV and non-VLS in LMICs between January 2015 and December 2023. Participants with VL ≤50 copies/mL were considered fully suppressed and those with VL ≥1000 copies/mL were non-suppressed. Using random effects models, we computed the pooled prevalence of LLV, non-VLS, and their corresponding 95% confidence intervals (CIs). We compared pooled prevalence of LLV and non-VLS between children vs adults and between studies done in Africa vs Asia.
Sixteen studies with 1 159 317 people living with HIV were analyzed. Overall, pooled prevalence of LLV was 19.7% (95% CI: 15.8-23.6) and that of non-VLS was 8.6% (95% CI: 6.5-10.7). Prevalence of LLV was significantly higher among children compared to adults (25.8% vs 17.2%; < 0.001) and higher among studies done in Africa compared to those in Asia (22.3% vs 15.6%; < 0.001). Prevalence of non-VLS was higher among studies involving children compared to adults (17.7% vs 5.6%; < 0.001), but lower among studies done in Africa compared to Asia 8.3% vs 9.0%; < 0.001). Overall, LLV increased the risk of non-VLS on a subsequent VL test compared to fully suppressed (RR = 2.6; 95% CI: 2.2-3.1).
LLV was associated with an increased risk of non-VLS. Stakeholders should consider reviewing guidelines for the threshold of VLS given that LLV was consistently associated with increased risk of non-VLS across all groups.
世界卫生组织（WHO）将低水平病毒血症（LLV）定义为病毒载量（VL）为51 - 999拷贝/毫升，且LLV与病毒学失败和耐药风险增加相关。在主要采用WHO指南进行HIV项目监测的低收入和中等收入国家（LMICs），相关信息有限。我们估计了LMICs中HIV感染者的LLV合并患病率、非病毒载量抑制（VLS）情况以及LLV与非VLS之间的关联。
在这项系统评价和荟萃分析中，检索数据库以查找2015年1月至2023年12月期间报道LMICs中LLV与非VLS之间关联的文章。VL≤50拷贝/毫升的参与者被视为完全抑制，VL≥1000拷贝/毫升的参与者为未抑制。使用随机效应模型，我们计算了LLV、非VLS的合并患病率及其相应的95%置信区间（CIs）。我们比较了儿童与成人之间以及非洲与亚洲开展的研究之间LLV和非VLS的合并患病率。
分析了16项研究，共纳入1159317名HIV感染者。总体而言，LLV的合并患病率为19.7%（95%CI：15.8 - 23.6），非VLS的合并患病率为8.6%（95%CI：6.5 - 10.7）。儿童中LLV的患病率显著高于成人（25.8%对17.2%；<0.001），非洲开展的研究中LLV的患病率高于亚洲（22.3%对15.6%；<0.001）。涉及儿童的研究中非VLS的患病率高于成人（17.7%对5.6%；<0.001），但非洲开展的研究中非VLS的患病率低于亚洲（8.3%对9.0%；<0.001）。总体而言，与完全抑制相比，LLV会增加后续VL检测中非VLS的风险（RR = 2.6；95%CI：2.2 - 3.1）。
LLV与非VLS风险增加相关。鉴于LLV在所有组中均与非VLS风险增加持续相关，利益相关者应考虑审查VLS阈值指南。
