Abstract: During antiretroviral therapy (ART), some people living with human immunodeficiency virus (HIV) may still experience persistent or recurrent low-level viremia (LLV), whose clinical significance has attracted increasing attention in long-term follow-up management. In recent years, research on LLV has expanded from virologic failure and drug resistance to non-AIDS-defining events, including cardiovascular, kidney, and metabolic outcomes. Cohort studies have reported associations between LLV and increased risks of certain clinical outcomes; however, findings remain inconsistent, with differences in LLV and outcome definitions, classification of viremia patterns, and adjustment for confounding. Studies of immune and metabolic alterations have provided a biological basis for interpreting these associations, but current evidence remains insufficient to establish a causal relationship between LLV and cardiovascular-kidney-metabolic (CKM) outcomes. This review addresses the definition and clinical identification of LLV, with emphasis on clinical studies linking LLV to CKM-related outcomes. It analyzes differences in findings and their possible explanations, discusses potential links in the context of inflammatory and metabolic mechanisms, and summarizes key points for monitoring and comprehensive management, thereby providing a reference for long-term follow-up and comorbidity risk assessment in people living with HIV.