P-342. Persistent Low-Level Viremia is Associated with Virologic Failure Even Among People With HIV (PWH) Initiating Single Tablets Antiretroviral Therapy (ART) Regimens

TL;DR

The study finds that persistent low-level HIV viremia is linked to treatment failure even when patients are on single-tablet regimens.

Contribution

This study is among the first to examine the association between low-level viremia and virologic failure in patients starting single-tablet HIV regimens.

Findings

Persistent low-level viremia (pLLV) was strongly associated with virologic failure (adjusted HR 7.7).

High-level low-level viremia (hLLV) also increased the risk of virologic failure (adjusted HR 3.1).

About 26.6% of participants experienced low-level viremia after starting single-tablet regimens.

Abstract

Persistent Low-Level Viremia (pLLV) has been associated with Virologic Failure (VF). Use of Single Tablet ART Regimens (STRs) is associated with improved adherence and virologic outcomes. The prevalence and implications of LLV amongst PWH initiating STRs is not well-studied. We examined virologic implications of LLV in those initiating STRs in the US military HIV Natural History Study (NHS).Figure 1.Graphical Representation of Virologic Strata used in the analysisTable 1Baseline Characteristics of NHS participants initiating STRs With and Without Virologic Failure

Graphical Representation of Virologic Strata used in the analysis

Baseline Characteristics of NHS participants initiating STRs With and Without Virologic Failure

NHS participants have unrestricted access to care and medications, minimizing the barriers to achieving and maintaining virologic suppression (VS); included participants had ≥2 viral loads (VL) measured with an assay with a lower limit of detection of ≤50 copies/ml, 6 months post STR initiation. VF was defined as a VL ≥200 copies/mL on 2 consecutive determinations spanning at-least 30 days or any VL ≥1000 copies/mL after VS. Participants were categorized into mutually exclusive LLV categories: intermittent LLV (iLLV) (VL of 50–199 copies/mL on < 25% of measurements), pLLV (VL of 50–199 copies/mL on ≥25% of measurements), high-levels of low level viremia (hLLV) VL of 200–1000 copies/mL) that did not meet criteria for VF, and VS (all VL < 50 copies/mL), Figure 1. VL measurements during ART interruptions were not included. Participants were censored at last follow- up or at VF. Adjusted time updated Cox proportional hazards models were used to evaluate the association between prespecified risk factors and VF.Table 2Adjusted Hazard Ratios for Factors Associated with Virologic Failure Amongst Those Initiation Single Tablet ART Regiments

Adjusted Hazard Ratios for Factors Associated with Virologic Failure Amongst Those Initiation Single Tablet ART Regiments

A total of 990 participants (median age,28.5 years at STR initiation, 97% male and 45% African American) contributed a median of 5.8 years follow up and 9 VL measures; 63 participants (6.4%) experienced VF, Table 1. A total of 292 (26.6%) participants experienced LLV: pLLV (n=42, 1.2%), iLLV (n=173, 17.6%), or hLLV (n=77, 7.8%). Both pLLV (adjusted HR (aHR) 7.7 [95% CI: 3.2 – 18.4)] and hLLV were associated with VF (aHR 3.1 [95% CI: 1.6 – 5.8]). VF was also associated with suboptimal adherence, characterized by medication possession ratios of < 90%, Table 2.

LLV was common in participants initiating STRs, about 1 in 4 participants had one or more episodes. Even after adjusting for adherence, both pLLV and hLLV were associated with VF. Our observations suggest that pLLV is more than just a random phenomenon and argue for closer clinical monitoring of PWH with pLLV and hLLV on STRs.

All Authors: No reported disclosures

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