Incidence and impact of low-level viremia among people living with HIV who received protease inhibitor- or dolutegravir-based antiretroviral therapy

• Main Authors: Guan-Jhou Chen, Hsin-Yun Sun, Sui-Yuan Chang, Aristine Cheng, Yu-Shan Huang, Sung-Hsi Huang, Yi-Chia Huang, Yi-Ching Su, Wen-Chun Liu, Chien-Ching Hung
• Format: Article
• Language: English
• Published: Elsevier 2021-04-01
• Series: International Journal of Infectious Diseases
• Subjects: Integrase strand transfer inhibitor; Nucleoside reverse transcriptase inhibitor; Virological failure; Resistance-associated mutation; Genetic barrier
• Online Access: http://www.sciencedirect.com/science/article/pii/S1201971221001314

Objectives: The impact of very low-level viremia (VLLV) and low-level viremia (LLV) are rarely investigated among people living with HIV (PLWH) receiving dolutegravir- vs protease inhibitor (PI)-based antiretroviral therapy (ART). Methods: Virally suppressed PLWH receiving long-term PI-containing ART were included in this study. The incidences of developing VLLV (plasma HIV RNA load (PVL) 20–49 copies/ml), LLV (PVL 50–999 copies/ml), and virological failure (any PVL ≥ 1000 copies/ml) were compared between those switched to dolutegravir-based ART and those remaining on PI-containing ART. Results: A total of 183 PLWH were switched to dolutegravir-based regimens and 309 remained on PI-containing regimens. The incidences of VLLV and LLV were 26.5 and 13.2 per 100 person-years of follow-up in the dolutegravir group, respectively, and 17.1 and 7.0 per 100 person-years of follow-up in the PI group; there were no statistically significant differences after adjusting for confounders. The rate of virological failure was 1.3 per 100 person-years of follow-up in the dolutegravir group and 1.9 per 100 person-years of follow-up in the PI group (p = 0.32). Neither VLLV nor LLV was related to subsequent virological failure. Conclusions: Among virally suppressed PLWH, the risk of developing VLLV or LLV were similar between those switched to dolutegravir-based therapy and those who continued PI-based therapy. VLLV and LLV were not associated with subsequent virological failure.