Evidence map›Paper›PMID 39288983›Full record

SynthesisSexually transmitted infections2024

Managing low-level HIV viraemia in antiretroviral therapy: a systematic review and meta-analysis.

Drieda Zaçe, Lorenzo Vittorio Rindi, Mirko Compagno, Luna Colagrossi, Maria Mercedes Santoro, Massimo Andreoni, Carlo Federico Perno, Loredana Sarmati, Low-level HIV Viremia Consensus Panel

Abstract readSystematic ReviewMeta-Analysis
In one paragraph

Synthesis in Sexually transmitted infections, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Drieda ZaçeInfectious Disease Clinic, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy.ORCID 0000-0003-3623-6800
Lorenzo Vittorio RindiInfectious Disease Clinic, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy.ORCID 0000-0003-1233-7965
Mirko CompagnoInfectious Disease Clinic, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy.
Luna ColagrossiMicrobiology and Diagnostic Immunology, Bambino Gesu Paediatric Hospital, Roma, Italy.
Maria Mercedes SantoroDepartment of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.ORCID 0000-0002-6228-1114
Massimo AndreoniInfectious Disease Clinic, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy.
Carlo Federico PernoMicrobiology and Diagnostic Immunology, Bambino Gesu Paediatric Hospital, Roma, Italy.
Loredana SarmatiInfectious Disease Clinic, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy srmldn00@uniroma2.it.ORCID 0000-0003-1452-0333
Low-level HIV Viremia Consensus Panel

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveHIV-1 management has advanced significantly with antiretroviral therapy (ART), yet challenges persist, including low-level HIV-1 viraemia (LLV). LLV presents a complex scenario, with varied definitions in the literature, reflecting uncertainties in its clinical interpretation. Questions arise regarding the underlying mechanisms of LLV, whether it signifies ongoing viral replication or stems from other factors. This study aimed to systematically review strategies for LLV management, providing insights into optimal clinical approaches.

methodsMEDLINE, EMBASE, Cochrane Library, Web of Science and Canadian Agency for Drugs and Technologies in Health were searched for relevant literature on LLV management. We included studies published between 2004 and 2024, assessing interventions such as ART modification, genotypic resistance testing, adherence assessment, performing therapeutic drug monitoring, testing for chronic coinfections and assessing the viral reservoir via HIV DNA quantification. Meta-analyses were conducted where feasible.

resultsThe systematic review identified 48 eligible records. Findings indicated limited evidence supporting the effectiveness of ART regimen modification in achieving virological suppression among individuals with LLV. However, studies assessing genotypic resistance testing revealed a significant association between resistance-associated mutations and virological suppression during LLV. Adherence to ART emerged as a critical determinant of treatment efficacy, with interventions showing promise in achieving viral suppression. The clinical utility of therapeutic drug monitoring in managing LLV remained inconclusive. Gaps in the literature were identified regarding follow-up scheduling, managing concurrent chronic infections and assessing inflammatory markers in LLV management.

conclusionsWhile ART modification may not consistently achieve virological suppression, genotypic resistance testing may offer insights into treatment outcomes. Adherence to ART emerged as a crucial factor, necessitating tailored interventions. However, further research is needed to elucidate the clinical utility of therapeutic drug monitoring and other management strategies. The study highlights the importance of ongoing research to refine therapeutic approaches and improve patient outcomes in LLV management. PROSPERO REGISTRATION NUMBER: CRD42024511492.

Indexed as

HIV-1HIV InfectionsViremiaAnti-HIV AgentsDrug MonitoringDrug Resistance, ViralHumansViral LoadAnti-HIV AgentsAnti-HIV AgentsHIVMETA-ANALYSISSYSTEMATIC REVIEWViral Load

Identifiers

PMID39288983
PMCPMC11503136

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.