Abstract:
Persistent low-level viremia (PLLV) of 200-999 copies/ml has been reported as a risk factor for HIV virologic failure (VF). This
retrospective study was aimed at characterizing patients with PLLV, determining factors associated with VF, and determining the
effect of regimen change. Data were extracted from electronic medical records for HIV care and treatment. Patients’ characteristics
(N = 705) were as follows: a mean age of 42 years, majority female (55%), and 51% married. A majority (78.7%) had a history of
opportunistic infections in their ART lifetime. To determine factors associated with VF, 187 records on patients who maintained
PLLV and 12 on deceased patients at the time of data review were eliminated from the analysis, leaving 506 patient records. Out of
the 506, 89% (451/506) suppressed VL to nondetectable levels while 11% (55/506) had VF, and the difference was significant
(P = 0:0001). Virologic failure was significantly associated with ages 10-30 years (P < 0:05). Baseline VL ≥ 1000 (OR 3.929; P =
0:002) and 200-999 copies/ml (OR 4.062; P = 0:004) were associated with VF. During PLLV, factors associated with VF
included the following: PLLV of 200-999 copies/ml (P < 0:05), viral blips (OR 4.545; P = 0:0001), mean maximum VL (P < 0:05),
and age (P = 0:043). Married marital status was inversely associated with VF (OR 0.318; P = 0:026). Regimen change was not
significantly associated with virologic outcomes. However, patients who switched regimens to the second line had a high risk of VF
(P = 0:028; OR 3.203). Regimen change was significantly high (P < 0:05) among adolescents and patients with a start regimen of
2NRTI+1NNRTI. Most of the PLLV patients (89%) achieved nondetectable VL after their continued ART monitoring for at least
12 months. Therefore, PLLV was not an indicator of VF. However, a consistent VL of ≥200-999 copies/ml at baseline and more
than 12 months of ART care and treatment were significantly associated with VF. Patients with VL 200-999 copies/ml, adolescents,
and young adults require intensive ART monitoring and support.
