HIV/AIDS patients with low-level viremia in different states have variable risks of subsequent viral suppression failure: a large retrospective study in Chongqing

Objective To analyze the basic characteristics and influencing factors of low-level viremia (LLV) among treated HIV/AIDS patients in Chongqing and to examine the association between low-level viremia and virological failure. Methods Data from AIDS patients who were diagnosed and treated at the Chongqing Public Health Medical Treatment Center were collected. The incidence rates of LLV and virological failure (VF) were statistically analyzed. Univariate and logistic regression analyses were performed to analyze the risk factors of LLV in HIV-infected individuals, and the correlation between low-level viremia and viral suppression failure was analyzed. Results From 2013 to 2022, a total of 7,685 HIV/AIDS patients were diagnosed and administered standardized antiretroviral therapy, with follow-up, at our center. The numbers (percentages) of patients experiencing virologic suppression (VS), single low-level viremia (sLLV), viral blip (Blip), and persistent low-level viremia (pLLV) were 6,265 (81.5%), 897 (11.8%), 95 (1.2%), and 211 (2.7%), respectively. Direct virological failure (VF) occurred in 217 (2.8%) cases. Univariate analysis revealed that marital status, route of infection, age, WHO stage, baseline CD4 + T lymphocyte count (CD4), baseline HIV viral load, and initial core drug selection were associated with the occurrence of LLV. Logistic regression analysis suggested that older age in HIV-infected individuals, more advanced WHO stage, lower baseline CD4 + T lymphocyte count, higher baseline viral load, and use of non-nucleoside reverse transcriptase inhibitors (NNRTIs) were associated with an increased likelihood of developing LLV. KM survival curve analysis revealed that pLLV patients had the highest risk of VF, followed by Blip, whereas sLLV cases had a relatively low risk of VF ( p < 0.01). Conclusion Advanced age, late detection, and delayed treatment are independent risk factors of LLV in HIV patients after ART. The occurrence of LLV increases the risk of VF, with pLLV greatly increasing this risk.