Consequences of Low-level Viremia Among Women with HIV in the United States from 2003-2020 Restricted; Files Only
Aldredge, Amalia (Spring 2024)
Published
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
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