Incidence and impact of low-level viremia among people living with HIV who received protease inhibitor- or dolutegravir-based antiretroviral therapy.

Abstract Objectives The impact of very low-level viremia (VLLV) and low-level viremia (LLV) are rarely investigated among people living with HIV (PLWH) receiving dolutegravir- vs protease inhibitor (PI)-based antiretroviral therapy (ART). Methods Virally suppressed PLWH receiving long-term PI-containing ART were included. The incidences of developing VLLV (plasma HIV RNA load [PVL] 20-49 copies/mL), LLV (PVL 50-999 copies/mL) and virologic failure (any PVL ≥1000 copies/mL) were compared between those switched to dolutegravir-based ART and those remained on PI-containing ART. Results 183 PLWH were switched to dolutegravir-based regimens and 309 remained on PI-containing regimens. The incidences of VLLV and LLV were 26.5 and 13.2 per 100 person-years of follow-up (PYFU) for the dolutegravir group and 17.1 and 7.0 per 100 PYFU for the PI group, without statistically significant differences after adjusting for confounders. The rate of virologic failure was 1.3 per 100 PYFU for the dolutegravir group and 1.9 per 100 PYFU for the PI group (p = 0.32). Either VLLV or LLV was not related to subsequent virologic failure. Conclusions Among virally suppressed PLWH, the risks of developing VLLV or LLV were similar between those switched to dolutegravir-based therapy and those continued PI-based therapy. VLLV or LLV was not associated with subsequent virologic failure.