Low level viremia Guidance

Map_LLV_v6
Background 
ESAR developed a questionnaire to seek expert views on a number of topics related to HIV low level viremia.     
Two areas were identified as requiring discussion prior to the formulation of guidance: additional diagnostic testing and clinical management.    

Purpose
To formulate a guidance on the clinical management of low level viremia, based on the views of a global panel, graded according to a systematic review. 

Process
 

The questionnaire was sent out in 2013 and has now been repeated with some modifications to assess the differences in perception of low level viremia in this decade and to achieve consensus for the panel position paper that we are developing.  

In October-November 2023, a total of 130 key opinion leaders, including all ESAR Board & Council members, were initially approached; 97 (74.6%) confirmed their interest in participating. 

The questionnaire was sent on November 14, 2023, and closed on December 4, 2023. Ninety-four (96.9%) of the people who confirmed their interest responded to the survey. Forty-seven different countries are represented.

The results of the questionnaire were analyzed between December 2023 and April 2024, and then discussed in the Coordinating Committee between May and June 2024. In July 2024, the conclusions of the survey were presented to the full panel group for comment.

A review on low HIV viremia is underway (initial protocol submitted to PROSPERO: CRD42023491303). Starting from 935 articles identified and published between December 1, 2008, and December 1, 2023, 68 were retained after a strict selection. 
Graph+photo LLVG

Given the large number of articles included, a scoping review will be completed to assess the evidence for the recommendations, also based on the conclusions of the questionnaire.

CURRENT PROCESS by December 2024
- The references of the selected articles are now being reviewed to include additional articles. Subsequently, a selection of articles published after December 1, 2023, will be made to update the results of the review.
- Outline of the scoping review.
- Integration of panel results and scoping review.

NEXT STEPS by January-February 2025
- Share outline consensus paper with writing committee.
- Share draft consensus paper with panel members.

Panel members

ESAR low level viremia guidance global panel  
Tommaso Clemente - ITALY   
Annemarie M J Wensing - the NETHERLANDS   
Anthony Kelleher - AUSTRALIA  
Katharina Grabmeier-Pfistershammer - AUSTRIA  
Linos Vandekerckhove - BELGIUM  
Ricardo Diaz - BRAZIL  
Ivailo Alexiev Ivanov - BULGARIA  
Joseph Fokam - CAMEROON  
P Richard Harrigan - CANADA  
Gary Rubin - CANADA  
Wai Shing Leung - CHINA, HONG KONG  
Snjezana Zidovec Lepej - CROATIA  
Leondios G. Kostrikis - CYPRUS  
Jannik Fonager - DENMARK  
Nina Weis - DENMARK  
Aho Inka - FINLAND  
Vincent Calvez - FRANCE 
Charlotte Charpentier - FRANCE

Maka Gogia - GEORGIA 
Georg Behrens - GERMANY 
Patrick Braun - GERMANY 
Rolf Kaiser - GERMANY 
Thomas Seidel - GERMANY 
Christoph Spinner - GERMANY 
Eva Wolf - GERMANY 
Lartey Margaret - GHANA 
Evangelia Georgia Kostaki - GREECE 
Dimitrios Paraskevis - GREECE 
Botond Lakatos - HUNGARY 
Ishwar Gilada - INDIA 
Sanjay Pujari - INDIA 
Giovanni Villa - IRELAND 
Itzchak Levy - ISRAEL 
Orna Mor - ISRAEL 
Jonathan Schapiro - ISRAEL 
Antonella Castagna - ITALY 
Manuela Ceccarelli - ITALY 
Diego Ripamonti - ITALY 
Stefano Rusconi - ITALY 
Vincenzo Spagnuolo - ITALY 
Maurizio Zazzi - ITALY

Wataru Sugiura - JAPAN 
Reena Shah - KENYA 
Oksana Savicka - LATVIA 
Aleksandras G Gorobecas - LITHUANIA 
Iskandar Azwa - MALAYSIA 
Casper Rokx - the NETHERLANDS 
Arjen J Stam - the NETHERLANDS 
Jeroen van Kampen - the NETHERLANDS 
Berend van Welzen - the NETHERLANDS 
Anne-Marte Bakken Kran - NORWAY 
Justyna Kowalska - POLAND 
Milosz Parczewski - POLAND 
Ana Abecasis - PORTUGAL 
Simona Paraschiv - ROMANIA 
Ana Maria Tudor - ROMANIA 
Maja Stanojevic - SERBIA 
Chen Seong Wong - SINGAPORE 
Ricardo Massmann - SLOVAKIA 
Mario Poljak - SLOVENIA 
Janez Tomažic - SLOVENIA 
Lucia Hans - SOUTH AFRICA 
Diana Hardie - SOUTH AFRICA 
Lucas Hermans - SOUTH AFRICA 
L Marije Hofstra - SOUTH AFRICA 
Graeme Meintjes - SOUTH AFRICA 
Yunus Moosa - SOUTH AFRICA 
Gert van Zyl - SOUTH AFRICA 
Francois Venter - SOUTH AFRICA 
Jose Bernardino - SPAIN 
Luiz Buzon-Martin - SPAIN 
Federico Garcia - SPAIN 
Josep Maria Llibre - SPAIN 
Luz Martin-Carbonero - SPAIN 
Esteban Martinez - SPAIN 
Rocio Montejano Sanchez - SPAIN 
Andres Ruiz Sancho - SPAIN 
Per Björkman - SWEDEN 

Nele Brusselaers - SWEDEN
Olof Elvstam - SWEDEN
Joakim Esbjörnsson - SWEDEN 
Piotr Nowak - SWEDEN 
Anders Sönnerborg - SWEDEN 
Huldrych Günthard - SWITZERLAND 
Anna Hachfeld - SWITZERLAND 
Andrea Mastrangelo - SWITZERLAND 
Nan-Yu Chen - TAIWAN 
Nittaya Phanuphak - THAILAND 
Mohamed Chakroun - TUNISIA 
Ahmet Çağkan İnkaya - TURKEY 
Kezban Tulay Yalcinkaya - TURKEY 
Simon Collins - UK 
Anna Maria Geretti - UK 
Nicola Mackie - UK 

Tetiana Melnyk - UKRAINE 
Marta Vasylyev - UKRAINE 
Daniel Kuritzkes - USA 
Douglas Richman - USA 

Robert Shafer - USA 

Process overview
Tommaso Clemente - ITALY  
Arjen J Stam - the NETHERLANDS

Nele Brusselaers - SWEDEN
Olof Elvstam - SWEDEN
Anna Maria Geretti - UK 
P Richard Harrigan - CANADA  
Milosz Parczewski - POLAND  
Nicola Mackie - UK  
Vincenzo Spagnuolo - ITALY  
L Marije Hofstra - SOUTH AFRICA  
Francois Venter - SOUTH AFRICA  
Daniel Kuritzkes - USA  
Josep Maria Llibre - SPAIN  

Robert W Shafer - USA
Jonathan Schapiro - ISRAEL
Esteban Martinez - SPAIN
Per Björkman - SWEDEN
Charlotte Charpentier - FRANCE
Simon Collins - UK
Antonella Castagna - ITALY 

Annemarie M J Wensing - the NETHERLANDS    

Coordination 
Tommaso Clemente & Annemarie M J Wensing