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Low-Level Viremia Increased Mortality & Comorbidities
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"These findings add to mounting evidence that LLV [low level viremia] is
associated with worse clinical outcomes.....of note - Compared with individuals with VS, persons with NSV [not suppressed] had increased risk of AIDS, aHR 23.9 (95% CI 6.3-90.1)....NSV...... was associated with a
higher risk of SNAE [non AIDS event], aHR 2.8,"
Presented at CROI 2020
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Low-level viremia during ART and the risk of death, AIDS, and serious non-AIDS events -(03/31/20)
PLWH with viral load 200-999 were at greater risk for a comorbidity (Non-Aids Event), although no greater risk for such event if viral load was 50-199. But risk for death was increased if viral load was 50-199.
then published April 9 2020 in CID:
All-Cause Mortality and Serious Non-AIDS Events in Adults with Low-Level HIV Viremia during Combination Antiretroviral Therapy: Results from a Swedish Nationwide Observational Study
6,956 participants were followed for a median of 5.7 years. At the end of follow-up, 60% were
categorized as VS [viral suppression] , 9% as LLV, and 31% as NSV [non suppressed viremia].
SUMMARY- In this nationwide Swedish cohort, LLV 50-999 copies/mL during cART was independently
associated with increased all-cause mortality. Furthermore, persons with LLV in the higher
stratum (200-999 copies/mL) had higher risk of SNAE, whereas LLV was not linked to AIDSdefining
conditions.....several studies have found higher levels of blood biomarkers reflecting cellular immune activation [30], inflammation, innate immunity, coagulation, and cardiovascular risk [31-33] in ART recipients with LLV compared with those with undetectable viremia.
We grouped individuals starting cART 1996-2017 (identified from the Swedish InfCare HIV register) as virologic suppression (VS; <50 copies/mL), LLV (repeated viral load 50-999 copies/mL), and non-suppressed viremia (NSV; ≥1000 copies/mL). Separately, LLV was subdivided into 50-199 and 200-999 copies/mL (reflecting different definitions of virologic failure).
Results
6,956 participants were followed for a median of 5.7 years. At the end of follow-up, 60% were categorized as VS, 9% as LLV, and 31% as NSV. Compared with VS, LLV was associated with increased mortality (adjusted hazard ratio [aHR] 2.2, 95% confidence interval [CI] 1.3-3.6). This association was also observed for LLV 50-199 copies/mL (aHR 2.2, 95% CI 1.3-3.8), but was not statistically significant for LLV 200-999 copies/mL (aHR 2.1, 95% CI 0.96-4.7). LLV 50-999 copies/mL was not linked to increased risk of AIDS or SNAE, but in subanalysis, LLV 200-999 copies/mL was associated with SNAE (aHR 2.0, 95% CI 1.2-3.6).
In a subanalysis of participants in the LLV 50-199 category with regard to proportions of VL measurements ≥50 copies/mL (<25% vs. ≥25%), only those with ≥25% detectable VL had significantly increased mortality, aHR 3.3 (95% CI 1.8-6.4). Besides viremia profiles, the following were significantly associated with all-cause mortality: higher age, male sex, higher pre-ART CD4 cell counts, injection drug use, and treatment interruptions (Table S1)
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