Low level viremia is associated with Serious Non-AIDS Events in People Living with HIV

The consequences of low-level viremia in people living with HIV are unclear. We used data from the U.S. Military HIV Natural History Study (NHS) to examine the association of low-level viremia (LLV) and serious non-AIDS events (SNAEs). Included participants initiated antiretroviral therapy (ART) after 1996, had ≥3 viral loads (VLs) measured, using an assay with a lower limit of detection of <50 copies/mL, ≥6 months after ART initiation. VLs were categorized as lower levels of LLV (51-199 copies/mL), higher level of low-level viremia (HLLV-200-999 copies/mL), and virologic failure (VF- ≥200 copies/mL on 2 or more successive determinations or a single VL ≥1000 copies/mL), and virologic suppression (VS- i.e., VL <50 copies/mL). Viral blips [i.e., VLs between 50 and 999 copies/mL that are preceded and succeeded by VL <50 copies/mL] were analyzed in the VS category. Cox Proportional Hazards models were used to examine the association of LLV and SNAEs, adjusted hazard ratios and 95% CI are presented. A total of 439 (17.4%) SNAEs were recorded among the 2528 participants (93% male, 40% Caucasian, 43% African American) followed for a median of 11 years. In 8.5% and 4.6% of the participants, respectively, LLV and HLLV were the highest recorded viremia strata. Compared with VS, SNAEs were associated with LLV (1.3, [1.2 to 1.4]), HLLV (1.6, [1.5 to 1.7]), and VF (1.7, [1.7 to 1.8]). The results of this study suggest that LLV is associated with the occurrence of SNAEs and needs further study.