Abstract
IntroductionViral suppression prevents HIV transmission and disease progression, but socio-economic and clinical factors can hinder the goal of suppression. We evaluated factors associated with viral non suppression (VNS) and persistent viremia (PV) in people living with HIV (PLHIV) receiving antiretroviral therapy (ART) in Guatemala.MethodsWe conducted a cross sectional analysis using data from an ongoing cohort of PLHIV attending the largest HIV clinic in Guatemala. Univariable and multivariable analyses were conducted between PLHIV with viral suppression and detectable viremia. VNS was defined as most recent HIV RNA ≥ 200 copies/ml and PV as two consecutive HIV RNA ≥ 200 copies/ml.ResultsOf 664 participants, 13.3% had VNS and 7.1% had PV. In univariable analysis disaggregated by gender, low income, poor education, perceived difficulty attending healthcare, and alcohol use were associated with VNS in men while low CD4 at diagnosis, multiple prior ART regimens and treatment interruptions were significant in both genders. Multiple prior ART regimens (adjusted Odds Ratio (aOR) 2.82, [95% confidence interval (CI) 1.59, 4.99], p < 0.01), treatment interruptions (aOR 4.51, [95% CI 2.13, 9.58], p < 0.01), excessive alcohol consumption (aOR 2.56, [95% CI 1.18, 5.54], p < 0.05) perceived difficulty attending healthcare (aOR 2.07, [ 95% CI 1.25, 3.42], p < 0.01) and low CD4 at diagnosis (aOR 2.34, 95% [CI 1.30, 4.20], p < 0.01) were independently associated with VNS on multivariable regression.ConclusionsWe conclude that socio-economic and clinical factors influence viral suppression in our cohort and vary between men and women. Gender specific approaches are necessary to achieve the 90% suppression goal.
Highlights
Viral suppression prevents Human immunodeficiency virus (HIV) transmission and disease progression, but socio-economic and clinical factors can hinder the goal of suppression
Individuals failing to achieve viral suppression may progress to persistent viremia, which is associated with double the risk of virologic failure and with higher rates of all-cause mortality [9,10,11]
Our study found factors associated with viral non suppression (VNS) and persistent viremia (PV) among people living with HIV (PLHIV) in Guatemala, complementing prior findings about the modifiable and unmodifiable factors associated with detectable viremia in PLHIV on antiretroviral therapy (ART) [23,24,25,26,27,28]
Summary
Viral suppression prevents HIV transmission and disease progression, but socio-economic and clinical factors can hinder the goal of suppression. We evaluated factors associated with viral non suppression (VNS) and persistent viremia (PV) in people living with HIV (PLHIV) receiving antiretroviral therapy (ART) in Guatemala. Ortíz et al AIDS Res Ther (2021) 18:79 continue to experience setbacks in the fight against HIV. Such is the case of Latin America, where no countries have reached the 90–90–90 goal, HIV new infections increased by 7% in the past eight years and only 55% of all the diagnosed PLHIV are virally suppressed [2,3,4]. As HIV prevalence increases, viral suppression must be achieved in order to prevent new infections [5]. Individuals failing to achieve viral suppression may progress to persistent viremia, which is associated with double the risk of virologic failure and with higher rates of all-cause mortality [9,10,11]
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