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 < 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 < 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 < 200 cells/µL, and the presence of ≥1 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.
Önal et al. (Wed,) studied this question.