Association of HIV low-level viremia with CD4 count recovery among persons living with HIV during antiretroviral therapy in Dehong Prefecture, Southwest China in 2008–2021: a longitudinal study

The study included a total of 7,485 PLHIV who received ART between 2008 and 2021 in Dehong. The median follow-up duration was 8.5 years. At baseline, the participants had a median age of 36 years, with males accounting for 60.5%. The median CD4 cell count at baseline was 268 cells/µl. Results of GBTM demonstrated that 730 patients (9.8%) experience LLV trajectories and 2,125 patients (28.4%) reached CD4 count recovery during follow-up. Compared to participants with the trajectory of VL < 50 copies/ml, the probability of CD4 count recovery were lower among participants with the trajectories of LLV 50-199 copies/ml (adjusted odds ratio [aOR] 0.69, 95% confidence interval [CI] 0.63-0.76) and LLV 200-999 copies/ml (aOR 0.51, 95% CI 0.45-0.59), CONCLUSION: Sustained LLV is associated with poorer CD4 recovery among HIV patients who are receiving ART. Interventions to ensure that PLHIV maintain durably undetectable VL during treatment should be prioritized to achieve immune recovery.