ArticleHIV medicine2026
Effectiveness of switching regimen in people living with HIV and persistent low-level viraemia in the modern antiretroviral treatment era.
Article in HIV medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
13 authors.
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Abstract
objectivesPersistent low-level viraemia (pLLV) remains a clinical challenge despite antiretroviral therapy (ART). Evidence guiding optimal therapeutic management is still limited, particularly in the modern ART era dominated by second-generation integrase inhibitors. We aimed to evaluate virological outcomes following pLLV based on ART changes.
methodsCohort study on adult people living with HIV (PLWH) on ART with ≥1 pLLV episode since 2014. pLLV was defined as ≥2 consecutive viral loads 50-199 copies/mL ≥30 days apart, preceded by a viral load <50 copies/mL. The primary outcome was virological suppression (viral load <50 copies). Follow-up accrued from the first viral load 50-199 copies/mL (baseline) to virological suppression, virological failure (≥2 consecutive viral loads ≥200 or ≥1 viral load ≥1000 copies/mL), a second ART modification among those who had already switched once during the follow-up or the last available viral load. Predictors of time to virological suppression were evaluated using Cox regression, treating ART switch as a time-dependent variable.
resultsAmong 6794 PLWH in care, 451 (6.6%) experienced pLLV. After a median follow-up of 9.0 months, 81.2% achieved virological suppression and 3.5% developed virological failure. ART was switched in 176 (39.0%) individuals. ART switching was associated with a shorter time to virological suppression (adjusted hazard ratio = 2.1, 95% confidence interval = 1.7-2.7, p < 0.001), even in individuals on regimens with a higher barrier to resistance. Higher baseline viraemia was inversely associated with the hazard of virological suppression. Genotypic resistance data during pLLV were limited; however, resistance-associated mutations might have been potentially selected in 22 (4.9%) PLWH.
conclusionsIn the current ART era, switching ART during pLLV may shorten the time to virological suppression, even among individuals receiving regimens with a higher barrier to resistance. Prompt and careful evaluation of treatment optimization is reasonable in this setting.
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