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已发表论文
低水平病毒血症是接受抗逆转录病毒治疗的艾滋病病毒感染者患代谢综合征的独立危险因素：一项为期 6 年的回顾性队列研究
Authors Wang Z, Jin Y , Qian G
Received 9 July 2025
Accepted for publication 16 October 2025
Published 30 October 2025 Volume 2025:18 Pages 5627—5642
DOI https://doi.org/10.2147/IDR.S552365
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Oliver Planz
Zixuan Wang,1 Yong Jin,2 Guoqing Qian1
1Department of Infectious Diseases, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, People’s Republic of China; 2Department of Infectious Diseases, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang, People’s Republic of China
Correspondence: Guoqing Qian, Department of Infectious Diseases, The First Affiliated Hospital of Ningbo University, No. 1601 Airport South Road, Ningbo, Zhejiang, People’s Republic of China, Email bill.qian@outlook.com Yong Jin, Department of Infectious Diseases, Ningbo Yinzhou No.2 Hospital, No. 998 Qianhe North Road, Ningbo, Zhejiang, People’s Republic of China, Email yongjin1993@163.com
Purpose: Metabolic syndrome (MetS) in people living with HIV (PLWH) is more complicated and multifactorial than in the general population. HIV infection is increasingly recognized as a direct contributor to metabolic dysfunction. This study aims to assess the long-term risk of MetS in PLWH with low-level viremia (LLV) receiving antiretroviral therapy (ART).
Patients and Methods: In this 6-year retrospective cohort study, we analysed 848 PLWH receiving ART. Participants were classified into three viremia categories: no LLV (all HIV viral loads < 50 copies/mL or undetectable), LLV 51– 200 (two consecutive viral loads between 51– 200 copies/mL), and LLV 201– 500 (two consecutive viral loads between 201– 500 copies/mL). MetS incidence was assessed using time-dependent Cox regression analysis, while immune and metabolic trajectories were analyzed via linear mixed models. To further validate the robustness of our primary findings, sensitivity analyses stratified by ART regimens were performed.
Results: Over a median follow-up of 3.9 years, 31.3% of participants developed MetS. The incidence rates of MetS were 160.4, 136.6, and 83.0 cases per 1000 person-years in the LLV 201– 500, LLV 51– 200, and no LLV groups, respectively. Time-dependent Cox regression analysis demonstrated that LLV was an independent risk factor for MetS. Sensitivity analyses demonstrated that patients experiencing LLV, irrespective of ART regimen, had a persistently higher incidence of MetS. Additionally, LLV was associated with persistently elevated CD8 counts, reduced CD4 recovery, and worsening metabolic profiles.
Conclusion: LLV independently predicts MetS risk in PLWH on ART. LLV should be regarded not only as a virological concern but also as a metabolic risk factor that warrants closer clinical attention in the post-ART era.
Keywords: low-level viremia, metabolic syndrome, HIV, risk factor, antiretroviral therapy
1Department of Infectious Diseases, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, People’s Republic of China; 2Department of Infectious Diseases, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang, People’s Republic of China
Correspondence: Guoqing Qian, Department of Infectious Diseases, The First Affiliated Hospital of Ningbo University, No. 1601 Airport South Road, Ningbo, Zhejiang, People’s Republic of China, Email bill.qian@outlook.com Yong Jin, Department of Infectious Diseases, Ningbo Yinzhou No.2 Hospital, No. 998 Qianhe North Road, Ningbo, Zhejiang, People’s Republic of China, Email yongjin1993@163.com
Purpose: Metabolic syndrome (MetS) in people living with HIV (PLWH) is more complicated and multifactorial than in the general population. HIV infection is increasingly recognized as a direct contributor to metabolic dysfunction. This study aims to assess the long-term risk of MetS in PLWH with low-level viremia (LLV) receiving antiretroviral therapy (ART).
Patients and Methods: In this 6-year retrospective cohort study, we analysed 848 PLWH receiving ART. Participants were classified into three viremia categories: no LLV (all HIV viral loads < 50 copies/mL or undetectable), LLV 51– 200 (two consecutive viral loads between 51– 200 copies/mL), and LLV 201– 500 (two consecutive viral loads between 201– 500 copies/mL). MetS incidence was assessed using time-dependent Cox regression analysis, while immune and metabolic trajectories were analyzed via linear mixed models. To further validate the robustness of our primary findings, sensitivity analyses stratified by ART regimens were performed.
Results: Over a median follow-up of 3.9 years, 31.3% of participants developed MetS. The incidence rates of MetS were 160.4, 136.6, and 83.0 cases per 1000 person-years in the LLV 201– 500, LLV 51– 200, and no LLV groups, respectively. Time-dependent Cox regression analysis demonstrated that LLV was an independent risk factor for MetS. Sensitivity analyses demonstrated that patients experiencing LLV, irrespective of ART regimen, had a persistently higher incidence of MetS. Additionally, LLV was associated with persistently elevated CD8 counts, reduced CD4 recovery, and worsening metabolic profiles.
Conclusion: LLV independently predicts MetS risk in PLWH on ART. LLV should be regarded not only as a virological concern but also as a metabolic risk factor that warrants closer clinical attention in the post-ART era.
Keywords: low-level viremia, metabolic syndrome, HIV, risk factor, antiretroviral therapy