PURPOSE OF REVIEW: Low-level viremia (LLV) remains common in the modern HIV treatment era. We sought to clarify a unified definition of LLV, examine current LLV risk factors, assess outcomes for people with LLV, explore sex and gender differences, and evaluate management updates for people who develop LLV. RECENT FINDINGS: There continue to be varied definitions of LLV without standardization, making comparison of clinical research findings challenging. Potential LLV risk factors have expanded and early data suggest that poor antiretroviral therapy adherence is unlikely to be the cause of most LLV; further, integrase strand transfer inhibitor use may be protective. Recent studies confirm that LLV is associated with virologic failure among other negative outcomes including a trend toward development of non-AIDS comorbidities; these effects may be more pronounced among women. Additional research, including randomized clinical trials, evaluating different strategies for managing LLV is urgently needed to prevent negative outcomes in persons with HIV.