Characteristics and management of low‐level viraemia in people living with
HIV
in a resource‐limited setting: A multicentre retrospective study in
Greece
Lydia Leonidou, Giota Lourida, Konstantinos Protopapas, Charalampos D. Moschopoulos, Dimitrios Zoulas, Charisis Totsikas, Dimitrios Basoulis, Elpida Mastrogianni, Apostolos Beloukas, Maria Lagadinou, Markos Marangos, Vasileios Papastamopoulos, Antonios Papadopoulos, Mina Psichogiou Abstract
Objectives
Low‐level viraemia (LLV) persists in some people living with HIV despite antiretroviral therapy, raising concerns about virologic failure. We assessed the characteristics, management and outcomes of LLV in Greece, where next‐generation sequencing, therapeutic drug monitoring and electronic adherence monitoring are unavailable.
Methods
This retrospective multicentre study included people living with HIV from four Greek clinics who had achieved virological suppression for at least 6 months. LLV was defined as two consecutive HIV‐1 RNA measurements between 51 and 200 copies/mL. Patients were followed for 18 months, during which three subsequent viral load measurements were evaluated. Adherence was assessed using patient self‐report and documentation in the medical record.
Results
Among 3800 patients, 35 (0.9%) experienced LLV. Median age was 49 years, and 69% were male. Patients were treatment‐experienced (median 3.5 ART lines; median duration of viral suppression, 7 years), with 57% receiving high genetic‐barrier regimens. Baseline genotypic resistance data were available for 30 of 35 patients (85.7%), and clinically relevant resistance‐associated mutations were identified in 6 (20.0%). LLV resolved in 27 of 35 patients (77.1%), persisted in 7 (20.0%) and recurred in 1 (2.9%). No patient developed virologic failure. Presumed causes of LLV were unknown in 18 (51.4%), low adherence in 14 (40.0%) and drug–drug interactions in 3 (8.6%). ART was modified in 17 patients, of whom 13 (76.5%) achieved viral resuppression, most commonly after switching from lower‐ to higher‐genetic‐barrier regimens. One patient with persistent LLV developed lymphoma during follow‐up.
Conclusions
LLV was uncommon but clinically relevant in this multicentre Greek cohort and frequently resolved following targeted management. Adherence optimization and ART modification, particularly to higher genetic‐barrier regimens, were associated with viral resuppression in this cohort. Ongoing monitoring remains essential, especially in settings with limited access to advanced diagnostic tools.