The Journal of Infectious Diseases, June 2020
Persistence of detectable HIV despite perfect ART adherence can be worrisome, because reaching undetectable is a huge goal for many people living with HIV. Why then do some people become undetectable and others do not? We tried to answer this question using information gained from more than 300 participants of A5321. When participants entered A5321, many measurements and samples were taken. We looked at everything that has been done with these measurements and found that males (assigned at birth) and people who were more obese tended to not reach undetectable levels of HIV. Sex-based differences in viral loads have been seen for many years and more studies are ongoing to find out why obesity is important. Some researchers think HIV may hide in body tissues with lots of fat but we did not obtain fat biopsies in A5321 to look at this directly. It’s always beneficial to exercise, but now we see hints that people with lower body mass indexes were more likely to be undetectable. While this will not be true for everyone, it is one of the first insights into why certain people may not reach undetectable levels of HIV.
Editor’s Clinical Impact Statement: This study tells us ideas to look further into why people have low levels of virus detected despite being on HIV medicines. We still need to understand if these low levels of virus have an adverse impact on people.
Cyktor, J. C., Bosch, R. J., Mar, H., Macatangay, B. J., Collier, A. C., Hogg, E., Godfrey, C., Eron, J. J., McMahon, D. K., Mellors, J. W., Gandhi, R. T., & ACTG A5321 Team (2020). Male sex and obesity are associated with residual plasma HIV-1 viremia in persons on long-term antiretroviral therapy. The Journal of Infectious Diseases, jiaa373. Advance online publication. https://doi.org/10.1093/infdis/jiaa373