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Objectives: To investigate the association of low‐level viremia (LLV) with mortality among people living with HIV (PLHIV) on antiretroviral therapy (ART) in Dehong, Southwest China. Methods: We analysed data collected from a cohort of PLHIV on ART in Dehong. PLHIV were enrolled in this cohort after they started ART, with viral load (VL) tested once a year afterwards. Each VL level was then categorized into one of the four groups: <50, 50–199, 200–999 and ≥1000 copies/ml. VL levels of 50–199 and 200–999 copies/ml were defined as LLV. The VL level for each participant was re‐categorized and fitted into an extended Cox regression model as a time‐varying covariate to examine the associations of VL level with all‐cause and AIDS‐related deaths. Results: Among the included 7273 of 8762 PLHIV in this study, median age (interquartile range, IQR) was 36 (30–43) years and 59.9% were male. The patients were followed up for a median duration (IQR) of 6.2 (4.3–8.2) years. Compared with VL <50 copies/ml, LLV 200–999 copies/ml (adjusted hazard ratio [aHR] and 95% confidence interval [95% CI]: 1.56 [1.04, 2.32]) were associated with elevated risk of all‐cause mortality and LLV50‐199 (aHR [95% CI]: 1.00 [0.68, 1.45]) were not. Similarly, only LLV200‐999 copies/ml (aHR [95% CI]: 2.37 [1.36, 4.14]) corresponded to higher risk of AIDS‐related mortality. Conclusions: This study suggests that PLHIV on ART may have elevated death risks even though the viremia is suppressed at a low level. Interventions targeting PLHIV with LLV should be developed to reduce their mortality. [ABSTRACT FROM AUTHOR]

Background: The prevalence of liver complications is increasing among people living with HIV, and microbial translocation (MT) might play a vital role. We conducted a prospective cohort study to evaluate the association between plasma biomarkers of MT and liver fibrosis (LF) among people living with HIV in southwest China. Method: A total of 665 people living with HIV were enrolled at baseline and had at least one follow‐up visit during the 3‐year study period. We calculated the Liver Fibrosis Index (FIB‐4) to evaluate LF and measured plasma soluble CD14 (sCD14) and lipopolysaccharide‐binding protein (LBP) as surrogate biomarkers for MT. We used ordinal logistic regression to investigate correlates of LF at baseline and used a linear mixed model to examine the association between dynamic changes in MT biomarkers and LF. Results: Of the participants, 61 (9.17%) had advanced LF (FIB‐4 >3.25), and 193 (29.02%) had moderate LF (1.45 ≤ FIB‐4 ≤ 3.25). Patients with advanced LF had higher plasma levels of sCD14 and LBP than those with moderate or no LF, both at baseline and at follow‐up. The following factors were significantly associated with advanced LF: the highest quartile of LBP (adjusted odds ratio [aOR] = 1.69; 95% confidence interval [CI] 1.02~2.81), current intravenous drug use (aOR = 1.82; 95% CI 1.06~3.12), baseline CD4 <200 cells/μl (aOR = 3.25; 95% CI 2.13~4.95), hepatitis C virus coinfection (aOR = 2.52; 95% CI 1.41~4.51) and age >50 years (aOR = 32.66; 95% CI 15.89~66.36). LF progression (increasing FIB‐4) was significantly associated with increasing sCD14 level (β = 1.11; 95% CI 0.97~1.26; p < 0.001) with covariate adjustment. Conclusion: The significant relationship between MT and LF may reveal pathogenic mechanisms and potential intervention targets of liver complications among people living with HIV in China. [ABSTRACT FROM AUTHOR]