How relevant is the HIV low level viremia and how is its management changing in the era of modern ART? A large cohort analysis

L. Taramasso, L. Magnasco, B. Bruzzone, P. Caligiuri, G. Bozzi, S. Mora, E. Balletto, P. Tatarelli, M. Giacomini, A. Di Biagio

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Background: It is still unclear what might be the best management of people living with HIV (PLWHIV) with low level viremia (LLV) despite being on antiretroviral treatment (ART). Objectives: Aim of our study is to describe the clinical management of PLWHIV with LLV followed in a large cohort. Study design: Retrospective cohort study. Results: We included 1607 adult patients over a three-year period (2015–2017). Follow up continued until June, 30th 2019 or last available visit. We observed a low incidence of LLV (0.9 % in 2015, 0.7 % in 2016 and 0.4 % in 2017), with a total of 21 patients with persistent LLV (pLLV), i.e. two consecutive HIV-RNA determinations of 50–500 copies/ml after at least 4 months of viral suppression. Among them, 12 had low compliance to treatment. Genotype resistance test (GRT) was performed in 14 patients and demonstrated at least one resistance mutation in 85.7 %. We described three categories of patients with pLLV: i) those whose ART regimen was not adequate based on GRT; ii) those with presumed suboptimal drug exposure, consequence of low adherence and/or drug-drug interactions and iii) those in which pLLV remained unexplained. For the first two categories, optimization or intensification of ART regimen led to viral suppression in >80 % of patients. We observed only 2 (9.5 %) virological failures and 1 (4.8 %) persistence of LLV in patients who did not switch ART. Conclusions: In our cohort, the rate of LLV showed a decline in most recent years. Adherence and previous GRT should be carefully considered with the aim of further reducing the phenomenon.

Original languageEnglish
Article number104255
JournalJournal of Clinical Virology
Publication statusPublished - 2020


  • Drug resistance mutations
  • GRT
  • HIV reservoir
  • Low level viremia
  • Residual viremia
  • Virological failure
  • integrase inhibitor
  • nonnucleoside reverse transcriptase inhibitor
  • proteinase inhibitor
  • virus RNA
  • adult
  • antiretroviral therapy
  • Article
  • cohort analysis
  • drug exposure
  • female
  • follow up
  • genotype
  • human
  • Human immunodeficiency virus
  • Human immunodeficiency virus 1 infection
  • Human immunodeficiency virus infected patient
  • incidence
  • major clinical study
  • male
  • medication compliance
  • middle aged
  • patient compliance
  • priority journal
  • retrospective study
  • RNA analysis
  • viremia
  • virus mutation


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