Understanding the dynamics of HIV infection is critical for managing and controlling the disease. A vital aspect of this understanding is the awareness of Low-Level Viremia (LLV), a condition experienced by about a third of people living with HIV. Despite its prevalence, there is a significant gap in clinical guidance on how to counsel and manage individuals with LLV.
LLV is characterized by different patterns, including intermittent occurrences, often referred to as “blips,” and persistent LLV. The lower limit of detection (LLOD) for virologic failure is defined as ≥200 copies/mL, and it is crucial to understand the relationship between these factors and LLV.
The importance of studying LLV in women stems from the association between increased cumulative HIV viral loads (virologic copy-years) and non-AIDS comorbidities, which are particularly prevalent in women. However, the contribution of LLV to these comorbidities is not fully understood, mainly because the majority of prior studies have been conducted in predominantly male populations.
To bridge this gap in understanding, a study was conducted to examine the relationship between LLV and time to virologic failure and multimorbidity in women with HIV. The study population included women with HIV who were enrolled in WIHS between 2003 and 2020, had been prescribed ART for at least 12 months, and had two consecutive VL <200 copies/mL.
The study’s design categorized virologic outcomes into four categories: Sustained Virologic Suppression, Intermittent Low-Level Viremia (iLLV), Persistent Low-Level Viremia (pLLV), and Virologic Failure (VF). Each category was defined based on the number of visits and the HIV-1 RNA (copies/mL) detected at each visit.
In the course of the study, the definitions and occurrence of Non-AIDS Comorbidities (NACM), including hypertension, dyslipidemia, type 2 diabetes, cardiovascular disease, and chronic kidney disease were also considered. The development of two or more of these NACMs was classified as “multimorbidity”.
The study’s findings indicated that 25% of the women had experienced LLV, which is lower than the figures reported in prior studies conducted on men. The women with LLV showed a higher risk of virologic failure and a trend toward a higher risk of multimorbidity.
These findings underscore the potential implications of LLV among women living with HIV. The higher risk of virologic failure suggests that LLV might be an indicator of the effectiveness of the current antiretroviral treatment (ART) regimen, leading to potential drug resistance and inflammation. These consequences, coupled with the trend towards a higher risk of multimorbidity, creates a complex medical situation that requires careful management.
The study also shed light on the demographic characteristics of the women included in the analysis. The median age was 47 years, with a majority identifying as non-Hispanic Black. Over half of the women reported an annual household income of less than $12,000, and approximately half had a body mass index (BMI) of 30 kg/m2 or higher, indicating obesity. The women’s HIV baseline characteristics, including CD4 count and adherence to ART, were also considered, providing a comprehensive picture of the study population.
This comprehensive approach allowed the researchers to adjust for variables such as age, race/ethnicity, CD4 count, adherence, and ART regimen when analyzing the risk of virologic failure and incident multimorbidity. The results showed a clear association between LLV and an increased risk of these outcomes, emphasizing the need for effective management strategies for women with HIV experiencing LLV.
While these findings provide essential insights into the implications of LLV in women with HIV, they also highlight the need for further research. The impact of sex and gender on LLV and its consequences is now being evaluated.
Currently, there are no established clinical guidelines on how to counsel and manage people with LLV, highlighting a significant gap in our collective knowledge and clinical practice. This void is even more alarming when considering that LLV is associated with virologic failure, the development of drug resistance, and inflammation. Furthermore, increased cumulative HIV viral loads, measured in virologic copy-years, have been linked to non-AIDS comorbidities, especially in women. However, the role of LLV in the development of these comorbidities is not yet fully understood, as the majority of prior studies have been conducted in predominantly male populations.
A study was conducted to examine the relationship between LLV and time to virologic failure and the development of multiple diseases (multimorbidity) in women with HIV. The study population was comprised of women with HIV who were enrolled in WIHS between 2003 and 2020, had been prescribed antiretroviral therapy (ART) for at least 12 months, and had two consecutive viral loads (VL) of <200 copies/mL.
The study’s design categorized virologic outcomes into four categories: Sustained Virologic Suppression, Intermittent Low-Level Viremia (iLLV), Persistent Low-Level Viremia (pLLV), and Virologic Failure (VF). Each category was defined based on the number of visits and the HIV-1 RNA (copies/mL) detected at each visit.
Additionally, the study considered the definition and occurrence of Non-AIDS Comorbidities (NACM), including hypertension, dyslipidemia, type 2 diabetes, cardiovascular disease, and chronic kidney disease. The development of two or more of these NACMs was classified as “multimorbidity”.
The study’s findings indicated that 25% of the women had experienced LLV, which is lower than the figures reported in prior studies conducted on men. Women with LLV showed a higher risk of virologic failure and a trend toward a higher risk of multimorbidity.
The demographic characteristics of the women included in the analysis were also considered. The median age was 47 years, with a majority identifying as Black, non-Hispanic. Over half of the women reported an annual household income of less than $12,000, and approximately half had a body mass index (BMI) of 30 kg/m2 or higher, indicating obesity. The women’s HIV baseline characteristics, including CD4 count and adherence to ART, were also considered, providing a comprehensive picture of the study population.
The findings of the study underscore the need for effective management strategies for women with HIV experiencing LLV. The higher risk of virologic failure suggests that LLV might be an indicator of the effectiveness of the current antiretroviral treatment (ART) regimen, leading to potential drug resistance and inflammation. These consequences, coupled with the trend towards a higher risk of multimorbidity, creates a complex medical situation that requires careful management.
While these findings provide essential insights into the implications of LLV in women with HIV, they also highlight the need for further research. The impact of sex and gender on LLV and its consequences is now being evaluated. This research is crucial as we strive to provide effective care for all individuals living with HIV and reduce the adverse effects of LLV.
In conclusion, understanding the role of LLV in the management of HIV, particularly among women, is crucial. The findings of the study underscore the need for increased attention towards this aspect in clinical practice and further research to develop comprehensive guidelines. The potential consequences of LLV, such as virologic failure and the development of non-AIDS comorbidities, necessitate a concerted effort to manage and mitigate these risks effectively.
The continued study and understanding of LLV are not only vital for the individual management of patients but also for our broader understanding of HIV as a whole. By continuing to study LLV, we can begin to fill the gaps in our knowledge and work towards more effective treatment strategies that take into account the unique experiences and needs of women living with HIV.
