Detectability of HIV residual viremia despite therapy is highly associated with treatment with a protease inhibitor-based combination ART.

Background: HIV persistence despite therapy contributes to chronic immune activation and inflammation, increasing the risk of aging-associated events in HIV-infected individuals.Objectives: To better understand the complex link between clinical and treatment features and HIV persistence despite therapy.Methods: 11045 samples from 1160 individuals under combination antiretroviral therapy (cART) with unquantifiable viral load (VL, limit of quantification: 20 copies/ml) were categorized as detectable or undetectable depending on the detection of a PCR signal using a commercially available assay. Generalized estimating equations regression was used to model viral load detectability and to assess determinants of residual viremia (RV: VL detected below 20 copies/ml) despite therapy.Results: High VL zenith was associated with a higher probability to have a detectable viremia under cART. Conversely, the probability to have a detectable viral load below 20 copies/ml decreased with time under therapy. Of therapy regimens, protease inhibitor (PI)-based cART was associated with a significantly higher probability of detectable RV compared to non-nucleoside transcriptase inhibitor- or integrase inhibitor-based cART.Conclusions: PI-based treatment regimen is highly associated with an increased frequency of RV, supporting the previous evidence suggesting that PI-based cART regimens could favor ongoing viral replication in some individuals.