Virologic Failure Following Low-level Viremia - Results Multicenter Cohort

[Jim Allen]

Interesting read, not unexpected or anything you would need to get your knickers in a twist about if you do experience a blip.

In Brief:

Viral load blips above the level of detection – typically an isolated measurement above 50 copies/ml – are a common phenomenon but researchers have been uncertain about their significance.

Some studies have suggested that they represent temporary releases of virus from the reservoir of latently infected cells, not ongoing virus replication.

Viral load blips above 50 copies/ml are associated with an increased risk but the study also found that the vast majority of people who experienced a viral blip or low-level viraemia went on re-suppress HIV and did not experience virologic failure.

Researchers in the EuResist network, a European research collaboration that studies HIV drug resistance, investigated the impact of viral blips and low-level viraemia in the largest population studied to date in a high-income setting. They identified 22,532 people who started treatment between 2005 and 2015 and had at least 12 months of follow-up after starting treatment, at HIV clinics in Germany, Spain, Italy, Luxembourg, Belgium and Portugal.

Participants were classified as follows:

- Persistent virologic suppression below 50 copies/ml
- Viral blips: a single viral load above 50 copies/ml
- Low-level viraemia: several viral loads between 51 and 199 copies/ml, at least 30 days apart

Virologic failure, the primary study outcome, was defined as two consecutive viral loads above 200 copies/ml or a single viral load above 1000 copies/ml.

During a median of 2.8 years of follow-up, 1,424 virologic failures occurred, 72% in people with previous virologic suppression, 15% in people who had experienced a viral blip and 13% in people with low-level viraemia.

After the first detectable viral load, 12% of those with low-level viraemia went on to experience virologic failure within two years, compared to 5% of those with viral blips.

Aidsmap.com writeup in full: https://www.aidsmap.com/news/oct-2022/low-level-hiv-and-viral-load-blips-are-important-warning-signals-european-study-finds

Study:
Olof Elvstam, Kasper Malmborn, Sixten Elén, Gaetano Marrone, Federico García, Maurizio Zazzi, Anders Sönnerborg, Michael Böhm, Carole Seguin-Devaux, Per Björkman, Virologic Failure Following Low-level Viremia and Viral Blips During Antiretroviral Therapy: Results From a European Multicenter Cohort, Clinical Infectious Diseases, 2022;, ciac762, https://doi.org/10.1093/cid/ciac762

[Shazam9cd4]

It is an interesting read.  Thanks for sharing. 

[leatherman]

Viral load blips above 50 copies/ml are associated with an increased risk but the study also found that the vast majority of people who experienced a viral blip or low-level viraemia went on re-suppress HIV and did not experience virologic failure.

50? Seems like 200 would have been more apt and would have ruled out those pesky micro-blips™ that newbies get so upset about.

"above 50" does sounds pretty mild though, doesn't it? But it can be pretty amazing too! Through the last 28 yrs of meds, I've had blips of 375, 2500, 7800, and even 59000. Every time within 2 tests (usually 2-4 months) I was back to UD

Virologic failure, the primary study outcome, was defined as two consecutive viral loads above 200 copies/ml or a single viral load above 1000 copies/ml.

So according to this definition, even though I returned to UD, without even having to change meds, I had multiple incidences of "virologic failure"?