Analysis of virologic outcome in low-level HIV-1 viremia patients in a small cohort

Aim: It is unclear whether a low-level viremia (LLV) status is maintained in HIV-infected patients. Materials & methods: HIV-infected patients with LLV were enrolled and followed up for 5 years. Factors associated with virological outcomes were assessed via regression analyses. Results: A total of 39 patients maintained an LLV status, whereas 19 had disease progression with a viral load of >= 1000 copies/ml. LLV duration and drug resistance (DR) were associated with virological failure. Among the DR cases, the most frequent mutations were M184V/I (70.4%) and K103N (40.7%). Protease inhibitor (PI) mutations were rare. Conclusion: There is an increased risk for virologic failure in HIV-1-infected patients maintaining LLV for a long time. DR was not a rare phenomenon in LLV patients. Plain language summary The outcomes of HIV-infected patients in a state of active virus replication for a long period of time remain unknown. After 5 years of follow-up, approximately 71.6% of patients with persistent HIV replication maintained a state of active virus replication and 46.6% experienced drug resistance (DR), although their immune function has recovered to a certain extent. The duration of active virus replication and DR were independently associated with poor outcomes. For cases with DR, the most commonly used antiretroviral drugs were nevirapine, efavirenz, abacavir and lamivudine. Routine monitoring and drug-resistance testing in patients with persistent HIV replication are necessary.