Case 2. How Low Can You Go? A Case of Non‑Suppressible Viremia

https://is1-ssl.mzstatic.com/image/thumb/Podcasts211/v4/ce/22/79/ce2279cb-1759-507e-2962-28c6b6e81258/mza_16246797511345587426.jpg/600x600bb.jpg

Viremic – Cases in HIV

Dr. Eileen Scully & Dr. Christopher Hoffmann

9 episodes

1 week ago

Hosted by Eileen Scully, MD, PhD, and Christopher Hoffmann, MD, MSC, MPH, both HIV specialists at Johns Hopkins, Viremic explores quandaries in adult HIV care. Each case discussion includes medical history and diagnoses, challenges in care and treatment, and key evidence and guidelines that informed clinical decision‑making. All clinical discussions presented on Viremic are for informational purposes only and are not offered as medical or clinical practice advice for patients or clinicians. Viremic is produced by the Clinical Guidelines Program, a collaborative effort of the New York State Department of Health AIDS Institute and the Johns Hopkins University Division of Infectious Diseases.

All content for Viremic – Cases in HIV is the property of Dr. Eileen Scully & Dr. Christopher Hoffmann and is served directly from their servers with no modification, redirects, or rehosting. The podcast is not affiliated with or endorsed by Podjoint in any way.

Medicine

Health & Fitness,

Science

Case 2. How Low Can You Go? A Case of Non‑Suppressible Viremia

Viremic – Cases in HIV

32 minutes

3 months ago

Case 2. How Low Can You Go? A Case of Non‑Suppressible Viremia

Mid-50s-yr-old man with HIV since the early 1990s presented for evaluation of persistent low-level viremia, despite consistent engagement in care and ART. Genotypic testing found only a variety of minor mutations. The patient and his care provider were concerned about the health consequences, including the risk of inflammatory diseases in the future, and about implications for U=U. After a brief discussion of the good news on lenacapavir for HIV prevention and a reminder about mpox vaccination, Drs. Scully and Hoffmann delve into the patient’s history to uncover the source of his LLV and treatment options.

References Cited

Broyles LN, Luo R, Boeras D, Vojnov L. The risk of sexual transmission of HIV in individuals with low-level HIV viraemia: a systematic review. Lancet. 2023;402(10400):464-471. PMID: 37490935.
Esber A, Polyak C, Kiweewa F, et al. Persistent Low-level Viremia Predicts Subsequent Virologic Failure: Is It Time to Change the Third 90? Clin Infect Dis. 2019;69(5):805-812. PMID: 30462188
Fleming J, Mathews WC, Rutstein RM, et al. Low-level viremia and virologic failure in persons with HIV infection treated with antiretroviral therapy. AIDS. 2019 Nov 1;33(13):2005-2012. PMID: 31306175
Hillus D, Le NH, Tober-Lau P, et al. Safety and effectiveness of MVA-BN vaccination against mpox in at-risk individuals in Germany (SEMVAc and TEMVAc): a combined prospective and retrospective cohort study. Lancet Infect Dis. Published online March 18, 2025. PMID: 40118087
Jatt LP, Mgodi NM, Buchbinder SP, Gray GE, Kublin JG. An HIV Vaccine in the Era of Twice-Yearly Lenacapavir for PrEP - Essential or Irrelevant? N Engl J Med. 2025;392(16):1561-1563. PMID: 40260855
White JA, Wu F, Yasin S, et al. Clonally expanded HIV-1 proviruses with 5'-leader defects can give rise to nonsuppressible residual viremia. J Clin Invest. 2023;133(6):e165245. Published 2023 Mar 15. PMID: 36602866.

Related Guidelines

NYSDOH AI Clinical Guidelines Program: Second-Line ART After Treatment Failure or for Regimen Simplification
Clinical Info HIV.gov: Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV. Management of People With HIV and Antiretroviral Therapy Experience: Virologic Failure