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% confidence Interval (CI): 0.63–0.78). Baseline DNA levels were significantly associated with viral rebound after viral suppression (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.为评估基线HIV-1 DNA水平的预后价值，本研究遵循PROSPERO注册方案（CRD42024619050），基于截至2025年3月4日已发表的研究数据开展了一项荟萃分析。研究从Web of Science、PubMed、Cochrane图书馆、Embase及Scopus数据库中检索相关文献。采用R软件计算效应量，包括相关系数、比值比（Odds Ratios, ORs）、风险比（Hazard Ratios, HRs）及校正风险比（Adjusted Hazard Ratios, aHRs），并开展亚组分析、发表偏倚评估与敏感性分析。最终纳入17项研究，共涉及4789名受试者。抗逆转录病毒治疗（Antiretroviral Therapy, ART）前与治疗中HIV-1 DNA水平的合并相关系数为0.71（95%置信区间（Confidence Interval, CI）：0.63~0.78）。基线HIV-1 DNA水平与病毒抑制后的病毒反弹显著相关，合并比值比为1.74（95%CI：1.25~2.41），风险比为2.01（95%CI：1.58~2.56），校正风险比为2.26（95%CI：1.75~2.92）。针对临床进展结局，基线连续HIV-1 DNA水平的合并风险比及校正风险比分别为3.66（95%CI：2.87~4.66）与2.44（95%CI：1.87~3.20）；基线高HIV-1 DNA水平与临床进展风险升高显著相关，对应风险比为2.58（95%CI：1.96~3.39），校正风险比为1.90（95%CI：1.41~2.55）。针对死亡结局，合并风险比及校正风险比分别为3.22（95%CI：1.96~5.29）与2.15（95%CI：1.21~3.84）；基线高HIV-1 DNA水平与死亡风险升高显著相关，对应风险比为3.54（95%CI：1.39~9.00），校正风险比为2.86（95%CI：1.01~8.08）。抗逆转录病毒治疗前更高的HIV-1 DNA水平与病毒反弹、临床进展及死亡风险升高显著相关。上述结果表明，基线HIV-1 DNA可作为监测疾病进展与治疗应答的潜在有价值的补充生物标志物。