BACKGROUND It is still unclear what might be the best management of people living with HIV (PLWHIV) with low level viremia (LLV) despite being on antiretroviral treatment (ART). OBJECTIVES Aim of our study is to describe the clinical management of PLWHIV with LLV followed in a large cohort. STUDY DESIGN Retrospective cohort study. RESULTS We included 1607 adult patients over a three-year period (2015-2017). Follow up continued until June, 30th 2019 or last available visit. We observed a low incidence of LLV (0.9 % in 2015, 0.7 % in 2016 and 0.4 % in 2017), with a total of 21 patients with persistent LLV (pLLV), i.e. two consecutive HIV-RNA determinations of 50-500 copies/ml after at least 4 months of viral suppression. Among them, 12 had low compliance to treatment. Genotype resistance test (GRT) was performed in 14 patients and demonstrated at least one resistance mutation in 85.7 %. We described three categories of patients with pLLV: i) those whose ART regimen was not adequate based on GRT; ii) those with presumed suboptimal drug exposure, consequence of low adherence and/or drug-drug interactions and iii) those in which pLLV remained unexplained. For the first two categories, optimization or intensification of ART regimen led to viral suppression in >80 % of patients. We observed only 2 (9.5 %) virological failures and 1 (4.8 %) persistence of LLV in patients who did not switch ART. CONCLUSIONS In our cohort, the rate of LLV showed a decline in most recent years. Adherence and previous GRT should be carefully considered with the aim of further reducing the phenomenon.

中文翻译：

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在现代抗逆转录病毒治疗时代，艾滋病毒低水平病毒血症有多重要，其管理方式如何变化？大型队列分析。

背景技术尽管接受抗逆转录病毒治疗（ART），但对于低病毒血症（LLV）的HIV感染者（PLWHIV）的最佳管理方法仍是未知的。目的本研究的目的是描述在大队列研究中采用LLV治疗PLWHIV的临床方法。研究设计回顾性队列研究。结果我们纳入了三年（2015-2017）期间的1607名成年患者。随访一直持续到2019年6月30日或最后一次访问。我们观察到LLV的发生率较低（2015年为0.9％，2016年为0.7％，2017年为0.4％），共有21例持续性LLV（pLLV）患者，即连续两次HIV-RNA测定为50-500份/至少经过4个月的病毒抑制后才能达到毫升。其中12例对治疗的依从性较低。对14例患者进行了基因型抗药性测试（GRT），结果证明至少有一种抗药性突变占85.7％。我们描述了pLLV的三类患者：i）基于GRT的ART方案不足的患者；ii）那些认为药物接触不良的患者，依从性低和/或药物-药物相互作用低的结果，以及iii）pLLV仍无法解释的患者。对于前两个类别，ART方案的优化或强化可导致> 80％的患者受到病毒抑制。在未进行抗逆转录病毒治疗的患者中，我们仅观察到2（9.5％）的病毒学衰竭和1（4.8％）的LLV持续性。结论在我们的队列中，最近几年LLV的发病率呈下降趋势。应仔细考虑遵守和以前的GRT，以进一步减少这种现象。