Association Between Baseline HIV-1 DNA Levels and Clinical Outcomes in People Living with HIV: A Meta-Analysis of Cohort Studies

To assess the prognostic value of baseline HIV-1 DNA levels, a meta-analysis was conducted according to the PROSPERO protocol (CRD42024619050) based on data from studies published until March 4, 2025. Relevant studies were retrieved from the Web of Science, PubMed, Cochrane Library, Embase, and Scopus databases. Effect sizes (correlation coefficients, odds ratios [ORs], hazard ratios [HRs], and adjusted hazard ratios [aHRs]) were calculated using R software, with subgroup analyses and assessment of publication bias and sensitivity. Seventeen studies involving 4789 participants were included. The combined correlation coefficient between pre- and on-ART HIV-1 DNA levels was 0.71 (95% CI: 0.63–0.78). Baseline DNA levels were significantly associated with viral rebound after VS (combined OR = 1.74, 95% CI: 1.25–2.41; HR = 2.01, 95% CI: 1.58–2.56; aHR=2.26, 95% CI: 1.75–2.92). For clinical progression, the combined HR and aHR for continuous baseline DNA were 3.66 (95% CI: 2.87-4.66) and 2.44 (95% CI: 1.87-3.20), respectively, with high baseline DNA levels associated with an increased risk of clinical progression (HR = 2.58, 95% CI: 1.96-3.39; aHR=1.90, 95% CI: 1.41-2.55). For mortality, the HR and aHR were 3.22 (95% CI: 1.96-5.29) and 2.15 (95% CI: 1.21-3.84) respectively, with high baseline DNA levels associated with an increased risk of death (HR = 3.54, 95% CI: 1.39-9.00; aHR=2.86, 95% CI: 1.01-8.08). Higher pre-ART HIV-1 DNA levels are associated with increased risks of viral rebound, clinical progression, and mortality. These results suggest that baseline HIV-1 DNA represents a potentially valuable supplementary biomarker for monitoring disease progression and treatment response.