Reply to Bottanelli et al

To the Editor—We read with great interest the letter from Bottanelli et al that shows a clear association of increased body mass index (BMI) with residual viremia in 1774 people with human immunodeficiency virus type 1 (HIV-1) in the Mediterranean area. The authors confirm and greatly expand on our initial report on the association of measures of obesity with residual, low-level viremia on antiretroviral therapy (ART). We used a sensitive research-only assay to measure low-level viremia, but Bottanelli et al use a broadly accessible commercial assay in a much larger cohort. The individuals in this cohort had virus suppressed with ART for ≥4 years, which is comparable to our previous report in which the duration of ART was ≥4 years but in some participants as long as 16 years.