Abstract
BACKGROUND: Understanding the current status of low-level viremia (LLV) is necessary for controlling the spread of HIV globally. However, the existing data on LLV prevalence during antiretroviral therapy (ART) and LLV risk contributing to subsequent virologic failure (VF) is still scant in China. METHODS: A large sample size, retrospective cohort study was conducted in Hubei province, China between January 1, 2011 and October 30, 2023. The LLV incidence was evaluated according to the first viral load of each year. The risk factors associated with LLV and subsequent VF among people living with HIV (PLWH) were accessed. RESULTS: Totally, 25,607 PLWH managed by Hubei province Center for Disease Control and Prevention were screened, and 19,930 PLWH were eligible for the study. Of them, 18,052 received the first line ART, 1103 received the second line ART, and 963 received the third line ART. 2497 (13.8%) PLWH on first line, 189 (17.1%) PLWH on second line and 100 (10.4%) PLWH on third line ART experienced LLV, respectively.The LLV level between 51 and 199 copies/ml was the most common in both three groups. CD4 count < 200 cells/µL and older age at ART initiation were associated with higher risk of LLV among all PLWH and PLWH receiving the first line ART, and protease inhibitors (PIs) using was associated with the higher risk of LLV among all PLWH. Both LLV level among 51-199, 200-399 and 400-999 copies/mL were risk factors leading to VF occurrence. CONCLUSIONS: Close surveillance of HIV-VL is imperative among PLWH with CD4 count < 200 cells/µL, older age and PIs use for avoiding LLV occurrence. Clinical strategies should be strengthened among PLWH with LLV, given the increased vulnerability to subsequent VF.