The Prevalence of Low-level Viraemia and Its Association with Virological Failure in People Living With HIV: A Systematic Review and Meta-Analysis.

IF 8.4 2区医学 Q1 IMMUNOLOGY

Emerging Microbes & Infections Pub Date : 2024-12-27 DOI:10.1080/22221751.2024.2447613

Shengnan Zhao,Wenjing Wang,Sibo Li,Jiaze He,Wenshan Duan,Zhen Fang,Xiaoran Ma,Zhen Li,Caiping Guo,Wen Wang,Hao Wu,Tong Zhang,Xiaojie Huang

{"title":"The Prevalence of Low-level Viraemia and Its Association with Virological Failure in People Living With HIV: A Systematic Review and Meta-Analysis.","authors":"Shengnan Zhao,Wenjing Wang,Sibo Li,Jiaze He,Wenshan Duan,Zhen Fang,Xiaoran Ma,Zhen Li,Caiping Guo,Wen Wang,Hao Wu,Tong Zhang,Xiaojie Huang","doi":"10.1080/22221751.2024.2447613","DOIUrl":null,"url":null,"abstract":"Low-level viraemia (LLV) following antiretroviral therapy (ART) in people living with HIV (PLWH) has not received sufficient attention. To the determine the prevalence of LLV and its association with virological failure (VF), we systematically reviewed evidence-based interventions for PLWH. We searched PubMed, the Cochrane Library, Embase, and Web of Science from inception to 22 May 2024. Cohorts with samples sizes smaller than 1000 in size were excluded. Data from 16 cohort studies, encompassing 1,349,306 PLWH, revealed a pooled prevalence of LLV of 13.81%. Relative risk (RR) and 95% confidence intervals (CI) identified the following risk factors for LLV: viral load (VL) ≥ 105 copies/mL at baseline (1.79, 1.11-2.88), AIDS-defined illness at baseline (1.24, 1.10-1.40), and protease inhibitor-based regimen at ART initiation (1.53, 1.45-1.62) are the risk factors for LLV. Conversely, CD4 count ≥200 cells/μL at baseline (0.90, 0.82-0.98), non-nucleoside reverse transcriptase inhibitor-based regimen (0.81, 0.68-0.96) and the integrase strand transfer inhibitor (INSTI)-based regimen (0.60, 0.42-0.85) were associated with a reduced risk of LLV. Pooling the adjusted hazard ratio (aHR) and the 95% CI, we found that LLV increased the risk of VF with rising VL among 96,711 PLWH (aHR 2.77, 95% CI 2.03-3.76) and increased the risk of all-cause mortality at high VL levels among 14,229 PLWH (aHR 1.66, 95% CI 1.16-2.37). Therefore, the prevalence of LLV in PLWH should not be overlooked. This study aims to guide better management strategies to improve clinical outcomes in patients with LLV.","PeriodicalId":11602,"journal":{"name":"Emerging Microbes & Infections","volume":"64 1","pages":"2447613"},"PeriodicalIF":8.4000,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Emerging Microbes & Infections","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/22221751.2024.2447613","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"IMMUNOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Low-level viraemia (LLV) following antiretroviral therapy (ART) in people living with HIV (PLWH) has not received sufficient attention. To the determine the prevalence of LLV and its association with virological failure (VF), we systematically reviewed evidence-based interventions for PLWH. We searched PubMed, the Cochrane Library, Embase, and Web of Science from inception to 22 May 2024. Cohorts with samples sizes smaller than 1000 in size were excluded. Data from 16 cohort studies, encompassing 1,349,306 PLWH, revealed a pooled prevalence of LLV of 13.81%. Relative risk (RR) and 95% confidence intervals (CI) identified the following risk factors for LLV: viral load (VL) ≥ 105 copies/mL at baseline (1.79, 1.11-2.88), AIDS-defined illness at baseline (1.24, 1.10-1.40), and protease inhibitor-based regimen at ART initiation (1.53, 1.45-1.62) are the risk factors for LLV. Conversely, CD4 count ≥200 cells/μL at baseline (0.90, 0.82-0.98), non-nucleoside reverse transcriptase inhibitor-based regimen (0.81, 0.68-0.96) and the integrase strand transfer inhibitor (INSTI)-based regimen (0.60, 0.42-0.85) were associated with a reduced risk of LLV. Pooling the adjusted hazard ratio (aHR) and the 95% CI, we found that LLV increased the risk of VF with rising VL among 96,711 PLWH (aHR 2.77, 95% CI 2.03-3.76) and increased the risk of all-cause mortality at high VL levels among 14,229 PLWH (aHR 1.66, 95% CI 1.16-2.37). Therefore, the prevalence of LLV in PLWH should not be overlooked. This study aims to guide better management strategies to improve clinical outcomes in patients with LLV.

查看原文本刊更多论文

HIV感染者低水平病毒血症的流行及其与病毒学失败的关系：一项系统综述和荟萃分析。

艾滋病毒感染者（PLWH）抗逆转录病毒治疗（ART）后的低水平病毒血症（LLV）尚未得到足够的重视。为了确定LLV的患病率及其与病毒学失败（VF）的关系，我们系统地回顾了PLWH的循证干预措施。我们检索了PubMed、Cochrane图书馆、Embase和Web of Science从成立到2024年5月22日。样本量小于1000的队列被排除。来自16项队列研究的数据，包括1,349,306名PLWH，显示LLV的总患病率为13.81%。相对危险度（RR）和95%置信区间（CI）确定了LLV的以下危险因素：基线时病毒载量(VL)≥105拷贝/mL(1.79, 1.11-2.88)，基线时艾滋病定义的疾病（1.24,1.10-1.40），以及开始ART时基于蛋白酶抑制剂的方案（1.53,1.45-1.62）是LLV的危险因素。相反，CD4计数≥200细胞/μL基线（0.90,0.82-0.98），非核苷逆转录酶抑制剂方案（0.81,0.68-0.96）和整合酶链转移抑制剂（INSTI）方案（0.60,0.42-0.85）与LLV风险降低相关。综合校正后的风险比（aHR）和95% CI，我们发现在96711名PLWH中，LLV增加了VF的风险，随着VL的升高（aHR 2.77, 95% CI 2.03-3.76），并增加了14229名PLWH中高VL水平的全因死亡风险（aHR 1.66, 95% CI 1.16-2.37）。因此，不应忽视PLWH中LLV的患病率。本研究旨在指导更好的管理策略，以改善LLV患者的临床预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Emerging Microbes & Infections IMMUNOLOGY-MICROBIOLOGY

CiteScore

26.20

自引率

2.30%

发文量

276

审稿时长

20 weeks

期刊介绍： Emerging Microbes & Infections is a peer-reviewed, open-access journal dedicated to publishing research at the intersection of emerging immunology and microbiology viruses. The journal's mission is to share information on microbes and infections, particularly those gaining significance in both biological and clinical realms due to increased pathogenic frequency. Emerging Microbes & Infections is committed to bridging the scientific gap between developed and developing countries. This journal addresses topics of critical biological and clinical importance, including but not limited to: - Epidemic surveillance - Clinical manifestations - Diagnosis and management - Cellular and molecular pathogenesis - Innate and acquired immune responses between emerging microbes and their hosts - Drug discovery - Vaccine development research Emerging Microbes & Infections invites submissions of original research articles, review articles, letters, and commentaries, fostering a platform for the dissemination of impactful research in the field.