Non-suppressible viraemia during HIV-1 therapy: a challenge for clinicians.

In individuals receiving antiretroviral therapy (ART), persistent low-level viraemia not attributed to suboptimal ART adherence, detrimental pharmacological interactions, or drug resistance is referred to as non-suppressible viraemia (NSV). This Review presents recent findings in the virological characterisation of NSV, revealing that it consists of one or a few identical populations of plasma viruses without signs of evolution. This finding suggests that NSV originates from virus production by expanded HIV-infected cell clones, reflecting the persistence of the HIV reservoir despite ART. We discuss knowledge gaps regarding the management and the clinical consequences of NSV. The prevalence of NSV remains to be precisely determined and there is very little understanding of its effects on virological failure, HIV transmission, secondary inflammation, morbidity, and mortality. This issue, along with the absence of specific recommendations for the management of NSV in HIV clinical guidelines, underscores the complexities involved in treating individuals with NSV.
Competing Interests: Declaration of interests AE-C has received payment or honoraria for presentations from Gilead Sciences. RM has received payment or honoraria for presentations, and advisory fees; has participated on advisory boards; and has received support for attending meetings from Gilead Sciences, ViiV Healthcare, Janssen, Thera Technologies, GlaxoSmithKline, and Merk Sharp & Dohme. AP-M has received payment or honoraria for presentations and support for attending meetings from ViiV Healthcare, Gilead Sciences, and Merk Sharp & Dohme. FP has received consulting and speaker fees and support for attending meetings from Gilead Sciences, Janssen, Merk Sharp & Dohme, and ViiV Healthcare. JRA has received consulting fees and support for attending meetings from Gilead Sciences, ViiV Healthcare, Aelix, Janssen, and Merk Sharp & Dohme. All other authors declare no competing interests.
(Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)