Antiretroviral regimen switch and short-term viral suppression in persistent low-level viremia: A multicenter retrospective real-world cohort study in China

Background Persistent low-level viremia (pLLV) remains clinically challenging among people living with HIV (PWH) receiving antiretroviral therapy (ART), and whether ART regimen switching improves virologic outcomes remains controversial. Methods We conducted a multicenter retrospective real-world cohort study across seven Chinese medical institutions. Adults with pLLV (50 copies/mL ≤ plasma viral load [VL] < 1000 copies/mL) were included and classified into a non-switch (control) group or a switch group based on the management decision of treating physicians at pLLV. The primary outcome was viral suppression at week 48; week 24 and week 96 suppression were secondary. Adjusted odds ratios (aOR) and risk differences (aRD) were estimated using logistic regression. Longitudinal viral load and CD4 trends were assessed using rank-based nonparametric longitudinal models. Results 162 participants were included (97 control; 65 switch). Viral suppression at week 48 was 64.37% in the control group and 68.52% in the switch group (aOR 1.40, P = 0.427; aRD 0.07, P = 0.423). At week 24, suppression occurred in 40.98% and 50.00%, respectively (aOR 1.34, P = 0.521; aRD 0.07, P = 0.518). HIV RNA levels decreased and CD4 increased modestly over time in both groups without between-group differences. Conclusions In this retrospective cohort, regimen switching after pLLV was not associated with improved virologic suppression.