Characteristics and management of low-level viraemia in people living with HIV in a resource-limited setting: A multicentre retrospective study in Greece

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine Pub Date : 2026-10-02 Epub Date: 2026-08-06 DOI:10.1111/hiv.70295

Lydia Leonidou, Giota Lourida, Konstantinos Protopapas, Charalampos D. Moschopoulos, Dimitrios Zoulas, Charisis Totsikas, Dimitrios Basoulis, Elpida Mastrogianni, Apostolos Beloukas, Maria Lagadinou, Markos Marangos, Vasileios Papastamopoulos, Antonios Papadopoulos, Mina Psichogiou

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引用次数: 0

Abstract

Objectives

Low-level viraemia (LLV) persists in some people living with HIV despite antiretroviral therapy, raising concerns about virologic failure. We assessed the characteristics, management and outcomes of LLV in Greece, where next-generation sequencing, therapeutic drug monitoring and electronic adherence monitoring are unavailable.

Methods

This retrospective multicentre study included people living with HIV from four Greek clinics who had achieved virological suppression for at least 6 months. LLV was defined as two consecutive HIV-1 RNA measurements between 51 and 200 copies/mL. Patients were followed for 18 months, during which three subsequent viral load measurements were evaluated. Adherence was assessed using patient self-report and documentation in the medical record.

Results

Among 3800 patients, 35 (0.9%) experienced LLV. Median age was 49 years, and 69% were male. Patients were treatment-experienced (median 3.5 ART lines; median duration of viral suppression, 7 years), with 57% receiving high genetic-barrier regimens. Baseline genotypic resistance data were available for 30 of 35 patients (85.7%), and clinically relevant resistance-associated mutations were identified in 6 (20.0%). LLV resolved in 27 of 35 patients (77.1%), persisted in 7 (20.0%) and recurred in 1 (2.9%). No patient developed virologic failure. Presumed causes of LLV were unknown in 18 (51.4%), low adherence in 14 (40.0%) and drug–drug interactions in 3 (8.6%). ART was modified in 17 patients, of whom 13 (76.5%) achieved viral resuppression, most commonly after switching from lower- to higher-genetic-barrier regimens. One patient with persistent LLV developed lymphoma during follow-up.

Conclusions

LLV was uncommon but clinically relevant in this multicentre Greek cohort and frequently resolved following targeted management. Adherence optimization and ART modification, particularly to higher genetic-barrier regimens, were associated with viral resuppression in this cohort. Ongoing monitoring remains essential, especially in settings with limited access to advanced diagnostic tools.

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资源有限环境下艾滋病毒感染者低水平病毒血症的特点和管理：希腊一项多中心回顾性研究

目的：尽管抗逆转录病毒治疗，一些HIV感染者仍然存在低水平病毒血症（LLV），这引起了对病毒学失败的关注。我们评估了希腊LLV的特征、管理和结局，在希腊，下一代测序、治疗药物监测和电子依从性监测是不可用的。方法：这项回顾性多中心研究纳入了来自希腊四家诊所的HIV感染者，这些患者已达到病毒学抑制至少6个月。LLV定义为连续两次在51 - 200拷贝/mL之间的HIV-1 RNA测量。患者随访18个月，在此期间评估了三次后续病毒载量测量。依从性通过患者自我报告和病历文件进行评估。结果：3800例患者中，35例（0.9%）发生LLV。中位年龄为49岁，69%为男性。患者接受过治疗（中位数为3.5个抗逆转录病毒治疗系；中位数病毒抑制持续时间为7年），其中57%接受高遗传屏障方案。35例患者中有30例（85.7%）获得了基线基因型耐药数据，6例（20.0%）发现了临床相关的耐药相关突变。35例患者中27例（77.1%）LLV消退，7例（20.0%）持续，1例（2.9%）复发。没有患者出现病毒学失败。18例（51.4%）患者的LLV原因不明，14例（40.0%）患者的依从性低，3例（8.6%）患者的药物-药物相互作用。在17例患者中对ART进行了修改，其中13例（76.5%）实现了病毒再抑制，最常见的是在从低遗传屏障方案转为高遗传屏障方案后。1例持续性LLV患者在随访期间发展为淋巴瘤。结论：在这个多中心的希腊队列中，LLV并不常见，但与临床相关，并且经常在靶向治疗后得到解决。在这个队列中，依从性优化和抗逆转录病毒治疗修饰，特别是对更高的遗传屏障方案，与病毒再抑制有关。持续监测仍然至关重要，特别是在无法获得先进诊断工具的情况下。

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

HIV Medicine 医学-传染病学

CiteScore

5.10

自引率

10.00%

发文量

167

审稿时长

6-12 weeks

期刊介绍： HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.