{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T17:15:43Z","timestamp":1793812543454,"version":"4.6.1"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T00:00:00Z","timestamp":1663113600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Department of Research and Development, Region Kronoberg, V\u00e4xj\u00f6","id":[{"id":"https:\/\/ror.org\/044sy8h86","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Swedish State"},{"name":"ALF agreement"},{"DOI":"10.13039\/501100009780","name":"Region Sk\u00e5ne","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009780","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100011077","name":"Sk\u00e5ne University Hospital","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100011077","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>It is unclear whether low-level viremia (LLV), defined as repeatedly detectable viral load (VL) of &amp;lt;200 copies\/mL, and\/or transient viremic episodes (blips) during antiretroviral therapy (ART), predict future virologic failure. We investigated the association between LLV, blips, and virologic failure (VF) in a multicenter European cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>People with HIV-1 who started ART in 2005 or later were identified from the EuResist Integrated Database. We analyzed the incidence of VF (\u2265200 copies\/mL) depending on viremia exposure, starting 12 months after ART initiation (grouped as suppression [\u226450 copies\/mL], blips [isolated VL of 51\u2013999 copies\/mL], and LLV [repeated VLs of 51\u2013199 copies\/mL]) using Cox proportional hazard models adjusted for age, sex, injecting drug use, pre-ART VL, CD4 count, HIV-1 subtype, type of ART, and treatment experience. We queried the database for drug-resistance mutations (DRM) related to episodes of LLV and VF and compared those with baseline resistance data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During 81 837 person-years of follow-up, we observed 1424 events of VF in 22 523 participants. Both blips (adjusted subhazard ratio [aHR], 1.7; 95% confidence interval [CI], 1.3\u20132.2) and LLV (aHR, 2.2; 95% CI, 1.6\u20133.0) were associated with VF, compared with virologic suppression. These associations remained statistically significant in subanalyses restricted to people with VL &amp;lt;200 copies\/mL and those starting ART 2014 or later. Among people with LLV and genotype data available within 90 days following LLV, 49\/140 (35%) had at least 1 DRM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Both blips and LLV during ART are associated with increased risk of subsequent VF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciac762","type":"journal-article","created":{"date-parts":[[2022,9,10]],"date-time":"2022-09-10T08:45:00Z","timestamp":1662799500000},"page":"25-31","source":"Crossref","is-referenced-by-count":95,"title":["Virologic Failure Following Low-level Viremia and Viral Blips During Antiretroviral Therapy: Results From a European Multicenter Cohort"],"prefix":"10.1093","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3799-9869","authenticated-orcid":false,"given":"Olof","family":"Elvstam","sequence":"first","affiliation":[{"name":"Department of Translational Medicine, Lund University , Malm\u00f6 , Sweden"},{"name":"Department of Infectious Diseases, V\u00e4xj\u00f6 Central Hospital , V\u00e4xj\u00f6 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasper","family":"Malmborn","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, Lund University , Malm\u00f6 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sixten","family":"El\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, Lund University , Malm\u00f6 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"Marrone","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Virology, Karolinska University Hospital , Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Garc\u00eda","sequence":"additional","affiliation":[{"name":"Servicio de Microbiolog\u00eda, Hospital Clinico Universitario San Cecilio, Instituto de Investigac\u00edon Ibs. Granada, Ciber de Enfermedades Infecciosas, CIBERINFEC , Granada , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Zazzi","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnologies, University of Siena , Siena , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"S\u00f6nnerborg","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet , Stockholm , Sweden"},{"name":"Department of Infecious Diseases, Karolinska University Hospital , Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"B\u00f6hm","sequence":"additional","affiliation":[{"name":"Institute of Virology, Faculty of Medicine and University Hospital of Cologne, University of Cologne , Cologne , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carole","family":"Seguin-Devaux","sequence":"additional","affiliation":[{"name":"Department of Infection and Immunity, Luxembourg Institute of Health , Esch sur Alzette , Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Bj\u00f6rkman","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, Lund University , Malm\u00f6 , Sweden"},{"name":"Department of Infectious Diseases, Sk\u00e5ne University Hospital , Malm\u00f6 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,9,14]]},"reference":[{"key":"2023010809023649500_ciac762-B1","doi-asserted-by":"crossref","first-page":"2145","DOI":"10.1093\/cid\/ciz129","article-title":"Persistent low-level viremia while on antiretroviral therapy is an independent risk factor for virologic 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