{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T13:10:49Z","timestamp":1779887449425,"version":"3.53.1"},"reference-count":26,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Background: Durable virological suppression is achieved in the majority of people living with HIV (PLWH) receiving contemporary antiretroviral therapy (ART). However, a subset of patients experience persistent low-level viremia (LLV), the clinical relevance and underlying determinants of which remain incompletely understood. Methods: Adult PLWH followed between 1 January 2005 and 31 December 2025 were retrospectively evaluated. LLV was defined as detectable HIV-1 RNA &lt; 200 copies\/mL on at least two consecutive measurements during follow-up in individuals receiving ART for at least 6 months. Patients with sustained virological suppression served as controls. Propensity score matching (1:1) was performed using variables associated with LLV in univariate analyses. Multivariable logistic regression analysis was applied to identify factors independently associated with LLV, and a p value &lt; 0.05 was considered statistically significant. Results: Among 880 PLWH, 45 patients with LLV and 113 virologically suppressed controls were included. LLV was associated with lower baseline CD4+ T-cell counts, higher baseline HIV-1 RNA levels, delayed virological suppression at weeks 8 and 24, increased frequency of AIDS-defining illnesses and a higher prevalence of metabolic comorbidities, including hypertension, diabetes mellitus or dyslipidemia in univariate analysis. After propensity score matching, 32 patients remained in each group, with no clear association between low-level viremia and antiretroviral regimen class. Multivariable regression analysis showed baseline CD4+ T-cell count &lt; 200 cells\/\u00b5L, and the presence of \u22651 metabolic comorbidity (hypertension, diabetes mellitus or dyslipidemia) remained independently associated with LLV. Conclusions: Our findings suggest that LLV is associated with host-related factors rather than antiretroviral regimen failure. The coexistence of immunological impairment and metabolic comorbidities in patients with LLV underscores the importance of comprehensive clinical evaluation.<\/jats:p>","DOI":"10.3390\/v18060611","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T12:31:56Z","timestamp":1779885116000},"page":"611","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Low-Level Viremia in People Living with HIV: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6194-3254","authenticated-orcid":false,"given":"U\u011fur","family":"\u00d6nal","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uluda\u011f University, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2890-6392","authenticated-orcid":false,"given":"Egemen","family":"\u00d6zdemir","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uluda\u011f University, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6041-2194","authenticated-orcid":false,"given":"\u015eeyma","family":"\u00d6nc\u00fcl","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uluda\u011f University, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazel \u00d6zt\u00fcrk","family":"Belik","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uluda\u011f University, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7380-2501","authenticated-orcid":false,"given":"Esra","family":"Kazak","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uluda\u011f University, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasemin","family":"Heper","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uluda\u011f University, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2651-2034","authenticated-orcid":false,"given":"Harun","family":"A\u011fca","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Faculty of Medicine, Bursa Uluda\u011f University, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emel","family":"Y\u0131lmaz","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uluda\u011f University, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7530-1279","authenticated-orcid":false,"given":"Halis","family":"Akal\u0131n","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uluda\u011f University, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"ref_1","unstructured":"Turkish Society of Clinical Microbiology and Infectious Diseases (KL\u0130M\u0130K) (2024). HIV\/AIDS Diagnosis, Monitoring and Treatment Handbook, Version 3.0, Turkish Society of Clinical Microbiology and Infectious Diseases (KL\u0130M\u0130K). Available online: https:\/\/www.klimik.org.tr\/wp-content\/uploads\/2024\/02\/HIV-AIDS.El_.Kitabi_Surum.3.pdf."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1093\/infdis\/jiad039","article-title":"Varied Patterns of Decay of Intact Human Immunodeficiency Virus Type 1 Proviruses Over 2 Decades of Antiretroviral Therapy","volume":"227","author":"Gandhi","year":"2023","journal-title":"J. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2447613","DOI":"10.1080\/22221751.2024.2447613","article-title":"The prevalence of low-level viraemia and its association with virological failure in people living with HIV: A systematic review and meta-analysis","volume":"14","author":"Zhao","year":"2025","journal-title":"Emerg. Microbes Infect."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Yu, H., Yang, Y., Cao, D., Cao, Y., Shi, Y., Xiao, G., Li, P., Feng, Y., Wei, H., and Sun, J. (2025). Association of HIV low-level viremia with CD4 count recovery among persons living with HIV during antiretroviral therapy in Dehong Prefecture, Southwest China in 2008\u20132021: A longitudinal study. BMC Infect. Dis., 25.","DOI":"10.1186\/s12879-025-10940-4"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"6257","DOI":"10.2147\/IDR.S559296","article-title":"Risk factors associated with virological failure in HIV patients with low-level viremia: A retrospective study","volume":"18","author":"Yang","year":"2025","journal-title":"Infect. Drug Resist."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Lao, X., Zhang, H., Deng, M., Li, Q., Xiao, Q., He, L., Ma, L., Song, A., Liang, X., and Yu, F. (2024). Incidence of low-level viremia and its impact on virologic failure among people living with HIV who started an integrase strand transfer inhibitor: A longitudinal cohort study. BMC Infect. Dis., 24.","DOI":"10.1186\/s12879-023-08906-5"},{"key":"ref_7","unstructured":"European AIDS Clinical Society (EACS) (2026, April 01). EACS Guidelines, Version 13.0. Available online: https:\/\/www.eacsociety.org\/guidelines\/eacs-guidelines\/."},{"key":"ref_8","unstructured":"Panel on Antiretroviral Guidelines for Adults and Adolescents (2026, April 01). Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV, Available online: https:\/\/clinicalinfo.hiv.gov\/."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1093\/cid\/ciae321","article-title":"Consensus definitions of cytomegalovirus (CMV) infection and disease in transplant patients including resistant and refractory CMV for use in clinical trials: 2024 update from the transplant associated virus infections forum","volume":"79","author":"Ljungman","year":"2024","journal-title":"Clin. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1093\/clinids\/17.4.802","article-title":"1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults","volume":"17","author":"Castro","year":"1993","journal-title":"Clin. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/hiv.13585","article-title":"Clinical significance and management of low-level HIV viremia in the era of integrase strand transfer inhibitors","volume":"25","author":"Shi","year":"2024","journal-title":"HIV Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3193","DOI":"10.1038\/s41467-019-10884-9","article-title":"Determinants of HIV-1 reservoir size and long-term dynamics during suppressive ART","volume":"10","author":"Bachmann","year":"2019","journal-title":"Nat. Commun."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Hsu, D.C., Kerr, S.J., Iampornsin, T., Pett, S.L., Avihingsanon, A., Thongpaeng, P., Zaunders, J.J., Ubolyam, S., Ananworanich, J., and Kelleher, A.D. (2013). Restoration of CMV-specific CD4 T cells with ART occurs early and is greater in those with more advanced immunodeficiency. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0077479"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1136\/sextrans-2024-056199","article-title":"Management of low-level HIV viremia during antiretroviral therapy: Delphi consensus statement and appraisal of the evidence","volume":"100","author":"Rindi","year":"2024","journal-title":"Sex. Transm. Infect."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"5627","DOI":"10.2147\/IDR.S552365","article-title":"Low-level viremia as an independent risk factor for metabolic syndrome in people living with HIV receiving antiretroviral therapy: A 6-year retrospective cohort study","volume":"18","author":"Wang","year":"2025","journal-title":"Infect. Drug Resist."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Tao, X., Huang, L., Chen, J., Liao, L., Nong, A., Huang, L., Huang, R., Huang, L., Wang, S., and Huang, X. (2025). Low-level viremia increases the risk of diabetes mellitus in people with HIV in China: A 7-year retrospective longitudinal cohort study. BMC Med., 23.","DOI":"10.1186\/s12916-025-04166-z"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Botha-Le Roux, S., Elvstam, O., De Boever, P., Goswami, N., Magnusson, M., Nilsson, P.M., Strijdom, H., Bj\u00f6rkman, P., and Fourie, C.M.T. (2022). Cardiovascular Profile of South African Adults with Low-Level Viremia during Antiretroviral Therapy. J. Clin. Med., 11.","DOI":"10.3390\/jcm11102812"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Zhang, X., Xu, Q., Li, C., Zhang, Y., Jin, Y., Li, P., and Guo, H. (2025). Prevalence of low-level viremia and related influencing factors among people living with HIV in China: A systematic review and meta-analysis. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1661253"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1093\/cid\/ciae569","article-title":"HIV-1 low-level viremia predicts viral failure in participants on antiretroviral therapy in the Swiss HIV Cohort Study","volume":"81","author":"Lanz","year":"2025","journal-title":"Clin. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"193","DOI":"10.14744\/hnhj.2024.39145","article-title":"Predictors of low-level viremia in people living with HIV with unsuppressed viremia: A retrospective follow-up study in Izmir","volume":"64","author":"Akbulut","year":"2024","journal-title":"Haydarpasa Numune Med. J."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Akbulut, I., Varol, Z.S., Akca, V., Serin, B.G., Erogul, E., Odemi\u015f, I., Senbayrak, S., and Atalay, S. (2025). Multicenter study in T\u00fcrkiye of unsuppressed viremia in people living with human immunodeficiency virus: Aegean experience. BMC Infect. Dis., 25.","DOI":"10.1186\/s12879-025-10988-2"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1097\/QAI.0000000000001678","article-title":"Low-Level Viremia Is Associated with Clinical Progression in HIV-Infected Patients Receiving Antiretroviral Treatment","volume":"78","author":"Bernal","year":"2018","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1111\/hiv.13250","article-title":"Outcomes of persistent low-level viremia among HIV patients on antiretroviral therapy: A prospective cohort study","volume":"23","author":"Ding","year":"2022","journal-title":"HIV Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"ofae147","DOI":"10.1093\/ofid\/ofae147","article-title":"Low Level Viremia Is Associated with Serious non-AIDS Events in People with HIV","volume":"11","author":"Ganesan","year":"2024","journal-title":"Open Forum Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Eastburn, A., Scherzer, R., Zolopa, A.R., Benson, C., Tracy, R., Do, T., Bacchetti, P., Shlipak, M., Grunfeld, C., and Tien, P.C. (2011). Association of low level viremia with inflammation and mortality in HIV-infected adults. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0026320"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Serrano-Villar, S., P\u00e9rez-El\u00edas, M.J., Dronda, F., Casado, J.L., Moreno, A., Royuela, A., P\u00e9rez-Molina, J.A., Sainz, T., Navas, E., and Hermida, J.M. (2014). Increased risk of serious non-AIDS-related events in HIV-infected subjects on antiretroviral therapy associated with a low CD4\/CD8 ratio. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0085798"}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/18\/6\/611\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T12:47:09Z","timestamp":1779886029000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/18\/6\/611"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,27]]},"references-count":26,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["v18060611"],"URL":"https:\/\/doi.org\/10.3390\/v18060611","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,27]]}}}