PRESTIGIO RING: "Persistent low-level viremia with preserved immunological profile in people with multidrug-resistant HIV: is it time to defer switching?"

IF 1 4区医学 Q4 MICROBIOLOGY

New Microbiologica Pub Date : 2025-10-01

Tommaso Clemente, Martina Bottanelli, Daniele Armenia, Francesco Saladini, Antonella Castagna, Stefania Piconi, Vincenzo Spagnuolo

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引用次数: 0

Abstract

Persistent low-level viremia (LLV) in heavily treatment-experienced (HTE) people with HIV (PWH) harboring multidrug-resistant virus remains a challenging clinical scenario. We report two cases from the PRESTIGIO Registry of individuals with longstanding HIV infection, high cumulative genotypic resistance, and sustained LLV despite no current adherence issues. In both cases, a regimen confidently containing ≥2 fully active agents was not achievable without incorporating entry and/or capsid inhibitors. Through these cases, we highlight diagnostic and therapeutic uncertainties in the management of LLV, including: the unfeasibility of RNA-based genotyping, the limited availability of data on resistance assessment by DNA-based genotypic testing, and the possibility that such viremia stems from clonal viral production rather than active replication. Although both individuals maintained a stable immune profile and low transmission risk, these cases underscore the need for tailored guidance in managing LLV in HTE PWH.

本刊更多论文

presgio RING：“耐多药艾滋病病毒感染者持续低水平病毒血症并保留免疫特征：是否该推迟转换？”

在大量治疗经验（HTE）的HIV感染者（PWH）中存在多药耐药病毒的持续性低水平病毒血症（LLV）仍然是一个具有挑战性的临床情况。我们报告了两例来自prestige Registry的长期HIV感染、高累积基因型耐药性和持续LLV的病例，尽管目前没有依从性问题。在这两种情况下，如果不结合进入和/或衣壳抑制剂，则无法实现含有≥2种完全活性药物的方案。通过这些病例，我们强调了LLV管理中诊断和治疗的不确定性，包括：基于rna的基因分型的不可行性，基于dna的基因分型测试耐药评估数据的有限可用性，以及这种病毒血症源于克隆病毒产生而不是主动复制的可能性。尽管两个人都保持稳定的免疫状况和低传播风险，但这些病例强调了在HTE PWH中管理LLV的量身定制指导的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

New Microbiologica 生物-微生物学

CiteScore

2.20

自引率

5.60%

发文量

审稿时长

6-12 weeks

期刊介绍： The publication, diffusion and furtherance of research and study on all aspects of basic and clinical Microbiology and related fields are the chief aims of the journal.