1025. Consequences of Low-level Viremia Among Women with HIV in the United States
Authors: Aldredge Amalia , Christina Mehta Cyra , Collins Lauren F , Lahiri Cecile D , Alcaide Maria L L , DeHovitz Jack , Anastos Kathryn , Plankey Michael , Dionne Jodie A , Floris-Moore Michelle , Schneider Michael F , French Audrey L , Tien Phyllis C , Sheth Anandi N 
Published: November 2023

Abstract

Background
Low-level viremia (LLV) is common in people with HIV taking antiretroviral therapy (ART), and has been associated with virologic failure, resistance, and may increase the risk of non-AIDS comorbidities (NACM). However, despite sex-differential HIV pathogenesis, treatment response, and NACM risk, women have been underrepresented in prior studies.

Methods
We included Women’s Interagency HIV Study (WIHS) participants from 2003-2020 receiving ART for ≥1 year with ≥2 consecutive HIV-1 viral loads (VL) &lt; 200 c/mL. Women were then categorized using 4 consecutive VL measurements (virologic categorization period) and then followed for 5 years for outcomes assessment. At end of the virologic categorization period, women were categorized as: virologic suppression (VS; all VL undetectable), intermittent LLV (iLLV; non-consecutive detectable VL up to 199 c/mL), persistent LLV (pLLV; ≥2 consecutive detectable VL up to 199 c/mL), or virologic failure (VF; any VL ≥200 c/mL). Adjusted Cox proportional hazards models were used to estimate the association of virologic category with time to incident a) virologic failure, and b) multimorbidity (defined as ≥2 of 5 NACM [hypertension, dyslipidemia, diabetes, cardiovascular disease, kidney disease]).

Results
Of 1,598 participants, 275 (17%) had VF during virologic categorization period and were not included in analyses. Median age of included women was 47 years, 64% were Black, 21% were Hispanic, median CD4 652 cells/µL, and 89% reported ≥95% ART adherence. VS, iLLV, and pLLV occurred over a median of 18 months in 58%, 19%, and 6% respectively. Compared to VS, the adjusted hazard ratio (aHR) for incident virologic failure was 1.89 (95% CI 1.45-2.47) for iLLV and 2.31 (1.53-3.47) for pLLV. After excluding 543 women with baseline multimorbidity, aHR for incident multimorbidity was 0.84 (0.56-1.26) for iLLV and 1.61 (0.93-2.82) for pLLV (Figure 1).

Conclusion
iLLV or pLLV occurred in 25% of WIHS participants. Compared to women with VS, iLLV and pLLV were associated with increased virologic failure risk, whereas only pLLV was associated with increased multimorbidity risk, though the association did not persist after covariate adjustment. Research is needed to assess the effect of sex on LLV prevalence and consequences to inform clinical management of LLV.

Disclosures
Cyra Christina Mehta, PhD, MSPH, Merck: Grant/Research Support Lauren F. Collins, MD, MSc, Curio Science: Honoraria Cecile D. Lahiri, MD, MS, Merck: Grant/Research Support|Theratechnologies, LLC: Advisor/Consultant|Theratechnologies, LLC: Honoraria Maria L L. Alcaide, MD, Discidium Biosciences: Board Member|Gilead: Honoraria|Merk & Co: Honoraria|Senhwa Biosciences: Honoraria|Virology Education: Honoraria Michelle Floris-Moore, ViiV Healthcare: Advisor/Consultant Phyllis C. Tien, MD, MSc, Merck: Grant/Research Support