Consequences of Low-level Viremia Among Women with HIV in the United States from 2003-2020 Restricted; Files Only

Abstract

Background

The prevalence and associated sequelae of low-level viremia (LLV) are poorly characterized among women, despite sex differences in potential LLV consequences such as virologic failure, drug resistance, and non-AIDS comorbidities (NACM).

 

Methods

We included Women’s Interagency HIV Study participants from 2003-2020 who reported antiretroviral therapy use ≥1 year followed by ≥2 consecutive HIV-1 viral loads (VL) <200 c/mL. Four consecutive VL measurements were then used to categorize women at baseline as having: virologic suppression (VIROLOGIC SUPPRESSION; all VL undetectable), intermittent LLV (intermittent LLV; non-consecutive VL up to 199 c/mL), persistent LLV (persistent LLV; ≥2 consecutive VL up to 199 c/mL), or virologic failure (VIROLOGIC FAILURE; any VL ≥200 c/mL). Adjusted Cox proportional hazards models estimated the association of virologic category with time to incident a) virologic failure and b) multimorbidity (≥2 of 5 NACM) over 5-year follow-up.

 

Results

Of 1,598 women, median age was 47 years, 64% were Black, 21% were Hispanic, and median CD4 was 652 cells/µL. After median virologic categorization period of 18 months, we excluded 275 women with VIROLOGIC FAILURE; VIROLOGIC SUPPRESSION, intermittent LLV, and persistent LLV occurred in 58%, 19%, and 6%, respectively. Compared to women with VIROLOGIC SUPPRESSION, the adjusted hazard ratio (aHR) for incident virologic failure was 1.89 (95% CI 1.45-2.47) and 2.31 (1.53-3.47) for women with intermittent LLV and persistent LLV, respectively. After excluding 543 women with baseline multimorbidity, the aHR for incident multimorbidity was 0.84 (0.56-1.26) and 1.61 (0.93-2.82) for women with intermittent LLV and persistent LLV, respectively, compared with women who had VIROLOGIC SUPPRESSION.

 

Conclusions

One-quarter of women experienced LLV. Women with intermittent LLV and persistent LLV had an increased risk of virologic failure; persistent LLV was associated with increased multimorbidity risk, though the association was attenuated after covariate adjustment.

Table of Contents

Introduction/Background………………………………………………………………………….1

Methods……………………………………………………………………………………………3

Results………………………………………………………………………………………….….7

Discussion…………………………………………………………………………………………9

References…………………………………………………………………………………..……14

Tables and Figures……………………………………………………………………………….22

           Table 1…………………………………………………………………………………...22

           Table 2………………………………………………………………………………...…23

           Table 3…………………………………………………………………………………...26

           Table 4…………………………………………………………………………...………27

           Table 5…………………………………………………………………………………...28

           Table 6…………………………………………………………………….……………..29

           Table 7…………………………………………………………………….……………..30

           Table 8…………………………………………………………………….……………..31

           Figure 1…………………………………………………………………………………..32

           Figure 2…………………………………………………………………………………..33

           Figure 3…………………………………………………………………………………..34

           Figure 4…………………………………………………………………………………..35

           Figure 5…………………………………………………………………………………..36

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery
Stichwort	low-level viremia women with HIV virologic failure HIV
Committee Chair / Thesis Advisor	Jordan Kempker, Emory University
Committee Members	Cecile Lahiri, Emory University Anandi Sheth, Emory University

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