Persistent Low-level Viremia while on Antiretroviral Therapy Is an Independent Risk Factor for Virologic Failure

Christie Joya, Seung Hyun Won, Christina Schofield, Tahaniyat Lalani, Ryan C. Maves, Karl Kronmann, Robert Deiss, Jason Okulicz, Brian K. Agan, Anuradha Ganesan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

64 Scopus citations


Background: Whether persistent low-level viremia (pLLV) predicts virologic failure (VF) is unclear. We used data from the US Military HIV Natural History Study (NHS), to examine the association of pLLV and VF. Methods: NHS subjects who initiated combination antiretroviral therapy (ART) after 1996 were included if they had 2 or more VLs measured with a lower limit of detection of ≤50 copies/mL. VF was defined as a confirmed VL ≥200 copies/mL or any VL >1000 copies/mL. Participants were categorized into mutually exclusive virologic 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-level viremia (hLV) (VL of 200-1000 copies/mL), and continuous suppression (all VL <50 copies/mL). Cox proportional hazards models were used to evaluate the association between VF and LLV; hazard ratios and 95% confidence interval (CI) are presented. Results: Two thousand six subjects (median age 29.2 years, 93% male, 41% black) were included; 383 subjects (19%) experienced VF. After adjusting for demographics, VL, CD4 counts, ART regimen, prior use of mono or dual antiretrovirals, and time to ART start, pLLV (3.46 [2.42-4.93]), and hLV (2.29 [1.78-2.96]) were associated with VF. Other factors associated with VF include black ethnicity (1.33 [1.06-1.68]) and antiretroviral use prior to ART (1.79 [1.34-2.38]). Older age at ART initiation (0.71 [0.61-0.82]) and non-nucleoside reverse transcriptase inhibitor (0.68 [0.51-0.90]) or integrase strand transfer inhibitor use (0.26 [0.13-0.53]) were protective. Conclusion: Our data add to the body of evidence that suggests persistent LLV is associated with deleterious virologic consequences.

Original languageEnglish
Pages (from-to)2145-2152
Number of pages8
JournalClinical Infectious Diseases
Issue number12
StatePublished - 27 Nov 2019
Externally publishedYes


  • HIV
  • persistent low-level viremia
  • virologic failure


Dive into the research topics of 'Persistent Low-level Viremia while on Antiretroviral Therapy Is an Independent Risk Factor for Virologic Failure'. Together they form a unique fingerprint.

Cite this