Low-level viraemia among people living with HIV in Nigeria: a retrospective longitudinal cohort study

HIV transmission can occur with a viral load of at least 200 copies per mL of blood and low-level viraemia can lead to virological failure; the threshold level at which risk for virological failure is conferred is uncertain. To better understand low-level viraemia prevalence and outcomes, we analyse...

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Published in:	The Lancet global health Vol. 10; no. 12; pp. e1815 - e1824
Main Authors:	Chun, Helen M, Abutu, Andrew, Milligan, Kyle, Ehoche, Akipu, Shiraishi, Ray W, Odafe, Solomon, Dalhatu, Ibrahim, Onotu, Dennis, Okoye, McPaul, Oladipo, Ademola, Gwamna, Jerry, Ikpeazu, Akudo, Akpan, Nseobong M, Ibrahim, Jahun, Aliyu, Gambo, Akanmu, Sulaiman, Boyd, Mary A, Swaminathan, Mahesh, Ellerbrock, Tedd, Stafford, Kristen A, Dirlikov, Emilio, Ene, Uzoma, Onyenuobi, Chibuzor, Efuntoye, Timothy, Meribe, Chidozie, Ogbanufe, Obinna, Bassey, Orji, Fagbamigbe, Omodele J, Fagbemi, Ayodele, Bamidele, Moyosola, Audu, Israel, Adegoke, Dickson, Tapdiyel, Jelpe, Emeh, Anuri, Obanubi, Chris, Oke, Odafrenkhoa, Pals, Sherri, Boyd, Andrew T, Zeh, Clement, Ellenberger, Dennis, Williams-Sherlock, Michelle, Adebajo, Sylvia, Sabo, Uba, Bassey, Grace, Etubi, Eruona, Omole, Temi, Okonkwo, Prosper, Kolade, Temitope, Dakum, Patrick, Olanrewaju, Olayiwola, Oko, John O, Ayo, Inyang, Oyeledun, Bolanle, Odoh, Deborah, Adedokun, Oluwasanmi
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-12-2022
Subjects:	Cohort Studies HIV Infections - drug therapy HIV Infections - epidemiology HIV-1 Humans Longitudinal Studies Nigeria - epidemiology Retrospective Studies Viremia - drug therapy Viremia - epidemiology Nigeria
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Summary:	HIV transmission can occur with a viral load of at least 200 copies per mL of blood and low-level viraemia can lead to virological failure; the threshold level at which risk for virological failure is conferred is uncertain. To better understand low-level viraemia prevalence and outcomes, we analysed retrospective longitudinal data from a large cohort of people living with HIV on antiretroviral therapy (ART) in Nigeria. In this retrospective cohort study using previously collected longitudinal patient data, we estimated rates of virological suppression (≤50 copies per mL), low-level viraemia (51–999 copies per mL), virological non-suppression (≥1000 copies per mL), and virological failure (≥2 consecutive virological non-suppression results) among people living with HIV aged 18 years and older who initiated and received at least 24 weeks of ART at 1005 facilities in 18 Nigerian states. We analysed risk for low-level viraemia, virological non-suppression, and virological failure using log-binomial regression and mixed-effects logistic regression. At first viral load for 402 668 patients during 2016–21, low-level viraemia was present in 64 480 (16·0%) individuals and virological non-suppression occurred in 46 051 (11·4%) individuals. Patients with low-level viraemia had increased risk of virological failure (adjusted relative risk 2·20, 95% CI 1·98–2·43; p<0·0001). Compared with patients with virological suppression, patients with low-level viraemia, even at 51–199 copies per mL, had increased odds of low-level viraemia and virological non-suppression at next viral load; patients on optimised ART (ie, integrase strand transfer inhibitors) had lower odds than those on non-integrase strand transfer inhibitors for the same low-level viraemia range (eg, viral load ≥1000 copies per mL following viral load 400–999 copies per mL, integrase strand transfer inhibitor: odds ratio 1·96, 95% CI 1·79–2·13; p<0·0001; non-integrase strand transfer inhibitor: 3·21, 2·90–3·55; p<0·0001). Patients with low-level viraemia had increased risk of virological non-suppression and failure. Programmes should revise monitoring benchmarks and targets from less than 1000 copies per mL to less than 50 copies per mL to strengthen clinical outcomes and track progress to epidemic control. None.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Nigeria Low-Level Viremia Investigation Group Uzoma Ene, Chibuzor Onyenuobi, Timothy Efuntoye, Chibuzor Meribe, Obinna Ogbanufe, Orji Bassey, Omodele J Fagbamigbe, Ayodele Fagbemi, Mouosola Bamidele, Israel Audu, Dickson Adegoke, Jelpe Tapdiyel, Anuri Emeh, Chris Obanubi, Odafrenkhoa Oke, Sherri Pals, Andrew T Boyd, Clement Zeh, Dennis Ellenberger, Michelle Williams Sherlock, Sylvia Adebajo, Uba Sabo, Grace Bassey, Eruona Etubi, Temi Omole, Prosper Okonkwo, Temitope Kolade, Patrick Dakum, Olayiwola Olanrewaju, John O Oko, Inyang Ayo, Bolanle Oyeledun, Deborah Odoh, Oluwasnmi Adedokun. Nigeria Low-Level Viremia Investigation Group affiliations are in the appendix (pp 11–12). HMC and ED conceptualised the study. AE and KAS collected the data. KM curated the data. HMC, KM, and RWS developed the methods. HMC, AA, KM, SO, KAS, and ED conducted the formal analysis, with supervision from RWS. KM and KAS accessed and verified the data. HMC, AA, KM, and ED drafted the manuscript. All authors critically reviewed and revised the final manuscript. KM, KAS, and AE had full access to all the data in the study, and all authors have provided final approval to submit for publication. Members listed at the end of the paper and in the appendix Joint first authors Contributors
ISSN:	2214-109X 2214-109X
DOI:	10.1016/S2214-109X(22)00413-2