{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T11:38:49Z","timestamp":1790768329202,"version":"4.1.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2019,2,20]],"date-time":"2019-02-20T00:00:00Z","timestamp":1550620800000},"content-version":"vor","delay-in-days":4,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Infectious Disease Clinical Research Program"},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Whether persistent low-level viremia (pLLV) predicts virologic failure (VF) is unclear. We used data from the US Military HIV Natural History Study (NHS), to examine the association of pLLV and VF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>NHS subjects who initiated combination antiretroviral therapy (ART) after 1996 were included if they had 2 or more VLs measured with a lower limit of detection of \u226450 copies\/mL. VF was defined as a confirmed VL \u2265200 copies\/mL or any VL &gt;1000 copies\/mL. Participants were categorized into mutually exclusive virologic categories: intermittent LLV (iLLV) (VL of 50\u2013199 copies\/mL on &lt;25% of measurements), pLLV (VL of 50\u2013199 copies\/mL on \u226525% of measurements), high-level viremia (hLV) (VL of 200\u20131000 copies\/mL), and continuous suppression (all VL &lt;50 copies\/mL). Cox proportional hazards models were used to evaluate the association between VF and LLV; hazard ratios and 95% confidence interval (CI) are presented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Two thousand six subjects (median age 29.2 years, 93% male, 41% black) were included; 383 subjects (19%) experienced VF. After adjusting for demographics, VL, CD4 counts, ART regimen, prior use of mono or dual antiretrovirals, and time to ART start, pLLV (3.46 [2.42\u20134.93]), and hLV (2.29 [1.78\u20132.96]) were associated with VF. Other factors associated with VF include black ethnicity (1.33 [1.06\u20131.68]) and antiretroviral use prior to ART (1.79 [1.34\u20132.38]). Older age at ART initiation (0.71 [0.61\u20130.82]) and non-nucleoside reverse transcriptase inhibitor (0.68 [0.51\u20130.90]) or integrase strand transfer inhibitor use (0.26 [0.13\u20130.53]) were protective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our data add to the body of evidence that suggests persistent LLV is associated with deleterious virologic consequences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciz129","type":"journal-article","created":{"date-parts":[[2019,2,17]],"date-time":"2019-02-17T23:24:10Z","timestamp":1550445850000},"page":"2145-2152","source":"Crossref","is-referenced-by-count":98,"title":["Persistent Low-level Viremia While on Antiretroviral Therapy Is an Independent Risk Factor for Virologic Failure"],"prefix":"10.1093","volume":"69","author":[{"given":"Christie","family":"Joya","sequence":"first","affiliation":[{"name":"Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland"},{"name":"Division of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Hyun","family":"Won","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland"},{"name":"The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Schofield","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland"},{"name":"Division of Infectious Diseases, Madigan Army Medical Center, Tacoma, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahaniyat","family":"Lalani","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland"},{"name":"The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland"},{"name":"Division of Infectious Diseases, Naval Medical Center Portsmouth, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan C","family":"Maves","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland"},{"name":"Division of Infectious Diseases, Naval Medical Center San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Kronmann","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland"},{"name":"Division of Infectious Diseases, Naval Medical Center Portsmouth, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Deiss","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Okulicz","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland"},{"name":"Infectious Disease Service, San Antonio Military Medical Center, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian K","family":"Agan","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland"},{"name":"The Henry M. 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