{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T21:37:53Z","timestamp":1792618673280,"version":"4.5.0"},"reference-count":17,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Persistent low\u2010level viraemia (pLLV) remains a clinical challenge despite antiretroviral therapy (ART). Evidence guiding optimal therapeutic management is still limited, particularly in the modern ART era dominated by second\u2010generation integrase inhibitors. We aimed to evaluate virological outcomes following pLLV based on ART changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Cohort study on adult people living with HIV (PLWH) on ART with \u22651 pLLV episode since 2014. pLLV was defined as \u22652 consecutive viral loads 50\u2013199 copies\/mL \u226530\u2009days apart, preceded by a viral load &lt;50 copies\/mL. The primary outcome was virological suppression (viral load &lt;50 copies). Follow\u2010up accrued from the first viral load 50\u2013199 copies\/mL (baseline) to virological suppression, virological failure (\u22652 consecutive viral loads \u2265200 or \u22651 viral load \u22651000 copies\/mL), a second ART modification among those who had already switched once during the follow\u2010up or the last available viral load. Predictors of time to virological suppression were evaluated using Cox regression, treating ART switch as a time\u2010dependent variable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 6794 PLWH in care, 451 (6.6%) experienced pLLV. After a median follow\u2010up of 9.0\u2009months, 81.2% achieved virological suppression and 3.5% developed virological failure. ART was switched in 176 (39.0%) individuals. ART switching was associated with a shorter time to virological suppression (adjusted hazard ratio\u2009=\u20092.1, 95% confidence interval\u2009=\u20091.7\u20132.7,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), even in individuals on regimens with a higher barrier to resistance. Higher baseline viraemia was inversely associated with the hazard of virological suppression. Genotypic resistance data during pLLV were limited; however, resistance\u2010associated mutations might have been potentially selected in 22 (4.9%) PLWH.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In the current ART era, switching ART during pLLV may shorten the time to virological suppression, even among individuals receiving regimens with a higher barrier to resistance. Prompt and careful evaluation of treatment optimization is reasonable in this setting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hiv.70251","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T05:54:33Z","timestamp":1777528473000},"page":"1367-1375","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of switching regimen in people living with\n                    <scp>HIV<\/scp>\n                    and persistent low\u2010level viraemia in the modern antiretroviral treatment era"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6548-3427","authenticated-orcid":false,"given":"Tommaso","family":"Clemente","sequence":"first","affiliation":[{"name":"Infectious Diseases IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3041-4004","authenticated-orcid":false,"given":"Pierluigi","family":"Reali","sequence":"additional","affiliation":[{"name":"Infectious Diseases IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2447-6498","authenticated-orcid":false,"given":"Riccardo","family":"Lolatto","sequence":"additional","affiliation":[{"name":"Infectious Diseases IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5492-6835","authenticated-orcid":false,"given":"Flavia","family":"Passini","sequence":"additional","affiliation":[{"name":"Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7676-2450","authenticated-orcid":false,"given":"Girolamo","family":"Piromalli","sequence":"additional","affiliation":[{"name":"Infectious Diseases IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6486-2231","authenticated-orcid":false,"given":"Rebecka","family":"Papaioannu Borjesson","sequence":"additional","affiliation":[{"name":"Infectious Diseases IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7039-2611","authenticated-orcid":false,"given":"Gaia","family":"Catalano","sequence":"additional","affiliation":[{"name":"Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7962-7193","authenticated-orcid":false,"given":"Diana","family":"Canetti","sequence":"additional","affiliation":[{"name":"Infectious Diseases IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3601-7686","authenticated-orcid":false,"given":"Elena","family":"Bruzzesi","sequence":"additional","affiliation":[{"name":"Infectious Diseases IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8093-015X","authenticated-orcid":false,"given":"Emanuela","family":"Messina","sequence":"additional","affiliation":[{"name":"Infectious Diseases IRCCS San Raffaele Scientific Institute  Milan 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