Seroprevalence and viremia of hepatitis C virus among HIV-infected patients on ART with unsuppressed HIV viral load in Ethiopia.

There has been a significant increase in methamphetamine use among persons who use drugs in Vietnam in the last 5-10years. We examined the degree to which adherence to antiretroviral therapy (ART) mediates the relationship between recent methamphetamine use and unsuppressed HIV viral load among people who inject drugs (PWID) in Hai Phong, Vietnam. We recruited PWID from October 2016-October 2018 and enrolled HIV positive PWID into a cohort, with up to three years of total follow-up. We assessed relationships among recent methamphetamine use frequency, ART adherence and unsuppressed HIV viral load. Mediation analysis was used to estimate the total and natural direct effects of recent methamphetamine use on unsuppressed HIV viral load and the indirect effect proportion. We enrolled 792 HIV seropositive PWID into the cohort; approximately 75.9% reported high/perfect ART adherence at baseline and 81.3% were virally suppressed. In mediation analysis, the total effect for the association between methamphetamine use and unsuppressed HIV viral load (1000 copies/mL) was 3.94 (95% CI: 1.95, 7.96); the natural direct effect was 2.14 (95% CI: 1.29, 3.55); the proportion mediated by self-reported ART adherence was 0.444. Similar results were found when examining lower unsuppressed HIV viral load cutpoints of 250copies/mL and 500copies/mL. Methamphetamine use is associated with unsuppressed HIV viral load among PWID despite high levels of ART adherence. Further research is needed to better understand these relationships, with emphasis on potential biological pathways that may interact with ART.

New HIV infections among young women remains exceptionally high and to prevent onward transmission, UNAIDS set ambitious treatment targets. This study aimed to determine the prevalence, spatial variation and factors associated with unsuppressed HIV viral load at ≥400 copies per mL. This study analysed data from women aged 15–49 years from the HIV Incidence Provincial Surveillance System (HIPSS) enrolled in two sequential cross-sectional studies undertaken in 2014 and 2015 in rural and peri-urban KwaZulu-Natal, South Africa. Bayesian geoadditive model with spatial effect for a small enumeration area was adopted using Integrated Nested Laplace Approximation (INLA) function to analyze the findings. The overall prevalence of unsuppressed HIV viral load was 45.2% in 2014 and 38.1% in 2015. Factors associated with unsuppressed viral load were no prior knowledge of HIV status, had a moderate-to-low perception of acquiring HIV, not on antiretroviral therapy (ART), and having a low CD4 cell count. In 2014, women who ever consumed alcohol and in 2015, ever ran out of money, had two or more lifetime sexual partners, ever tested for tuberculosis, and ever diagnosed with sexually transmitted infection were at higher risk of being virally unsuppressed. The nonlinear effect showed that women aged 15 to 29 years, from smaller households and had fewer number of lifetime HIV tests, were more likely to be virally unsuppressed. High viral load risk areas were the north-east and south-west in 2014, with north and west in 2015. The findings provide guidance on identifying key populations and areas for targeted interventions.

Children living with perinatally-acquired HIV-1 (CPHIV) face significant health challenges despite advancements in antiretroviral therapy (ART). This study aimed to determine the association between unsuppressed HIV RNA viral load (VL), proinflammatory markers, sociodemographic, and clinical factors among CPHIV attending routine ART clinic at Arthur Davison Children's Hospital (ADH), Ndola, Zambia. We conducted a cross-sectional study on 135 CPHIV, aged 2-18 years, who had been on ART for over 12 months. Sociodemographic, clinical, and laboratory data were collected using a standardized questionnaire and a data collection form. The primary outcome was unsuppressed HIV RNA VL defined as a viral load greater than 1000 copies/mL of HIV-1 RNA after at least 6 months of ART treatment. Bivariate and multivariate logistic analyses were conducted to assess associations with unsuppressed HIV viral load. Overall median (Q1 - Q3) age was 15 years (12-17) and 59.3% were male. The proportion of CPHIV with unsuppressed HIV VL was 15.6% (n = 21, 95% confidence interval (CI): 9.9-22.8%). Factors associated with unsuppressed VL in multivariate logistic regression were poor adherence to ART (missing two or more doses in 2 weeks) (adjusted OR (AOR) = 14.96; 95% CI: 2.39-93.49, p = 0.004) and lower CD4 count (AOR; 0.99, 0.99-1.00, p = 0.026). Proinflammatory markers tumor necrosis factor-alpha (TNF-α) (p = 0.196) and D-dimer (p = 0.709) did not differ between the suppressed and unsuppressed CPHIV. One in six children with perinatally acquired HIV in Ndola, Zambia, had unsuppressed viral load, which was associated with poor ART adherence and lower CD4 counts. Proinflammatory markers, TNF-α and D-dimer, showed no significant differences between suppressed and unsuppressed groups, suggesting they may not be reliable indicators of viral control. Enhanced adherence support and further research on immune dysregulation are needed.

BackgroundChildren living with perinatally-acquired HIV-1 (CPHIV) face significant health challenges despite advancements in antiretroviral therapy (ART). This study aimed to determine the association between unsuppressed HIV RNA viral load (VL), proinflammatory markers, sociodemographic, and clinical factors among CPHIV attending routine ART clinic at Arthur Davison Children’s Hospital (ADH), Ndola, Zambia.MethodsWe conducted a cross-sectional study on 135 CPHIV, aged 2−18 years, who had been on ART for over 12 months. Sociodemographic, clinical, and laboratory data were collected using a standardized questionnaire and a data collection form. The primary outcome was unsuppressed HIV RNA VL defined as a viral load greater than 1000 copies/mL of HIV-1 RNA after at least 6 months of ART treatment. Bivariate and multivariate logistic analyses were conducted to assess associations with unsuppressed HIV viral load.ResultsOverall median (Q1 - Q3) age was 15 years (12–17) and 59.3% were male. The proportion of CPHIV with unsuppressed HIV VL was 15.6% (n = 21, 95% confidence interval (CI): 9.9–22.8%). Factors associated with unsuppressed VL in multivariate logistic regression were poor adherence to ART (missing two or more doses in 2 weeks) (adjusted OR (AOR) = 14.96; 95% CI: 2.39–93.49, p = 0.004) and lower CD4 count (AOR; 0.99, 0.99–1.00, p = 0.026). Proinflammatory markers tumor necrosis factor-alpha (TNF-α) (p = 0.196) and D-dimer (p = 0.709) did not differ between the suppressed and unsuppressed CPHIV.ConclusionOne in six children with perinatally acquired HIV in Ndola, Zambia, had unsuppressed viral load, which was associated with poor ART adherence and lower CD4 counts. Proinflammatory markers, TNF-α and D-dimer, showed no significant differences between suppressed and unsuppressed groups, suggesting they may not be reliable indicators of viral control. Enhanced adherence support and further research on immune dysregulation are needed.

Unsuppressed HIV viral load is an important marker of sustained HIV transmission. We investigated the prevalence, predictors, and high-risk areas of unsuppressed HIV viral load among HIV-positive men and women. Unsuppressed HIV viral load was defined as viral load of ≥400 copies/mL. Data from the HIV Incidence District Surveillance System (HIPSS), a longitudinal study undertaken between June 2014 to June 2016 among men and women aged 15–49 years in rural and peri-urban KwaZulu-Natal, South Africa, were analysed. A Bayesian geoadditive regression model which includes a spatial effect for a small enumeration area was applied using an integrated nested Laplace approximation (INLA) function while accounting for unobserved factors, non-linear effects of selected continuous variables, and spatial autocorrelation. The prevalence of unsuppressed HIV viral load was 46.1% [95% CI: 44.3–47.8]. Predictors of unsuppressed HIV viral load were incomplete high school education, being away from home for more than a month, alcohol consumption, no prior knowledge of HIV status, not ever tested for HIV, not on antiretroviral therapy (ART), on tuberculosis (TB) medication, having two or more sexual partners in the last 12 months, and having a CD4 cell count of <350 cells/μL. A positive non-linear effect of age, household size, and the number of lifetime HIV tests was identified. The higher-risk pattern of unsuppressed HIV viral load occurred in the northwest and northeast of the study area. Identifying predictors of unsuppressed viral load in a localized geographic area and information from spatial risk maps are important for targeted prevention and treatment programs to reduce the transmission of HIV.

Ongoing HIV transmission is related to prevalence, risk behavior and viral load among persons with HIV. We assessed the contribution of these factors to HIV transmission with transmission rate models and data reported to National HIV Surveillance and published rates of risk behavior. We also estimated numbers of persons with risk behaviors and unsuppressed viral load among sexual risk groups. The transmission rate is higher considering risk behavior (18.5 infections per 100 people with HIV) than that attributed to unsuppressed viral load (4.6). Since persons without risk behavior or suppressed viral load presumably transmit HIV at very low rates, transmission can be attributed to a combination of these factors (28.9). Service needs are greatest for MSM; their number with unsuppressed viral load engaging in unprotected discordant sex was 8 times the number of male heterosexuals and more than twice the number of female heterosexuals with high-risk transmission potential. While all persons with HIV need optimal care, treatment as prevention is most relevant when risk behavior is present among persons with unsuppressed HIV viral load.

To evaluate associations of mood, anxiety, stress-/trauma-related, and psychotic disorders, both treated and untreated, with duration of unsuppressed HIV viral load (VL) among persons living with HIV (PLWH). The DC Cohort, an observational clinical cohort of PLWH followed from 2011 to 2018 at 14 sites in Washington, DC. Among PLWH ≥18 years old who received primary care at their HIV clinic, we determined in a time-updated manner whether participants had diagnoses and pharmacologic prescriptions for mood, anxiety, stress-/trauma-related, and/or psychotic disorders. Associations between psychiatric disorders/treatments and the proportion of subsequent days with VL ≥200 copies/mL were assessed using multivariable Poisson regression with generalized estimating equations. Among 5904 participants (median age 51; 70% men; 82% Black), 45% had ≥1 psychiatric disorder, including 38% with mood disorders (50% treated), 18% with anxiety or stress-/trauma-related disorders (64% treated), and 4% with psychotic disorders (52% treated). Untreated major depressive disorder (adjusted rate ratio = 1.17; 95% confidence interval: 1.00 to 1.37), untreated other/unspecified depressive disorder (1.23; 1.01 to 1.49), untreated bipolar disorder (1.39; 1.15 to 1.69), and treated bipolar disorder (1.25; 1.02 to 1.53) (vs. no mood disorder) predicted more time with VL ≥200 copies/mL. Treated anxiety disorders (vs. no anxiety disorder) predicted less time (0.78; 0.62 to 0.99). Associations were weaker and nonsignificant for treated depressive disorders (vs. no mood disorder) and untreated anxiety disorders (vs. no anxiety disorder). PLWH with depressive and bipolar disorders, particularly when untreated, spent more time with unsuppressed VL than PLWH without a mood disorder. Treatment of mood disorders may be important for promoting sustained viral suppression.

BackgroundViral suppression among children living with HIV remains suboptimal in sub-Saharan Africa. The marked heterogeneity in suppression rates across countries underscores the need for comparative analyses to elucidate context-specific determinants. This systematic review aims to synthesize existing evidence on factors associated with unsuppressed viral loads in paediatric populations.MethodsA systematic review was conducted to examine viral load suppression among children under 15 years in sub-Saharan Africa. Comprehensive searches were performed across four major databases: PubMed, Google Scholar, Embase, and Web of Science. Eligible studies were published in English between 2010 and 2024, focused exclusively on paediatric populations in Africa, and available in full text. Relevant data were systematically extracted and compiled in a structured Excel database to prevent duplication and facilitate rigorous, methodologically sound analysis.ResultsOf the 161 articles initially identified, 16 met the predefined inclusion criteria for this review. These studies were conducted across multiple sub-Saharan African countries and used various methodological designs. The most frequently reported factors associated with an unsuppressed viral load among children receiving antiretroviral therapy (ART) were suboptimal treatment adherence, malnutrition, low maternal educational attainment, a high baseline viral load, and missed clinical appointments. Adherence to ART was the most extensively analysed variable, and poor adherence was consistently and strongly associated with virological failure.ConclusionViral suppression among children living with HIV in sub-Saharan Africa remains unacceptably low. This review emphasized key preventable factors mostly poor adherence. Targeted, urgent interventions are needed to improve outcomes for this vulnerable population.

Social genomics has demonstrated altered inflammatory and type I interferon (IFN) gene expression among people experiencing chronic social adversity. Adverse social experiences such as discrimination and violence are linked to stimulant misuse and HIV, conditions that dysregulate inflammatory and innate antiviral responses, leading to increased HIV viral replication and risk of chronic diseases. We aimed to determine whether methamphetamine (MA) use, unsuppressed HIV viral load (VL) (≥200 c/mL), and experienced intimate partner violence (IPV) (past 12 months) predicted inflammatory and type I IFN gene expression in HIV-positive Black and Latinx men who have sex with men (MSM). Participants were 147 HIV-positive Black and Latinx MSM recruited from the mSTUDY, a cohort of 561 MSM aged 18-45 in Los Angeles, CA, of whom half are HIV-positive and substance-using. Transcriptomic measures of inflammatory and type I IFN activity were derived from RNA sequencing of peripheral blood mononuclear cells and matched to urine drug tests, VL, and survey data across two time points 12 months apart. Analysis used linear random intercept modeling of MA use, unsuppressed VL, and experienced IPV on inflammatory and type I IFN expression. In adjusted models, MA use predicted 27% upregulated inflammatory and 31% upregulated type I IFN expression; unsuppressed VL predicted 84% upregulated type I IFN but not inflammatory expression; and experienced IPV predicted 31% upregulated inflammatory and 26% upregulated type I IFN expression. In Black and Latinx MSM with HIV, MA use, unsuppressed VL, and experienced IPV predicted upregulated social genomic markers of immune functioning.

Factors associated with HIV viral load suppression on antiretroviral therapy in Vietnam

To compare the vaginal microbiota of women living with HIV (WLWH) with the vaginal microbiota of women with recurrent bacterial vaginosis (BV) and healthy women without HIV to determine if there are differences in the vaginal microbiome, what factors influence these differences, and to characterise HIV clinical parameters including viral load and CD4 count in relation to the vaginal microbiome. Observational cohort study. Canada. Women aged 18-49years who were premenopausal and not pregnant were recruited into three cohorts: healthy women, WLWH and women with recurrent BV. Demographic and clinical data were collected via interviews and medical chart reviews. Vaginal swabs were collected for Gram-stain assessment and microbiome profiling using the cpn60 barcode sequence. To compare overall community composition differences, we used compositional data analysis methods, hierarchical clustering and Kruskal-Wallis tests where appropriate. Clinical markers such as odour and abnormal discharge, but not irritation, were associated with higher microbial diversity. WLWH with unsuppressed HIV viral loads were more likely than other groups to have non-Gardnerella-dominated microbiomes. HIV was associated with higher vaginal microbial diversity and this was related to HIV viral load, with unsuppressed women demonstrating significantly higher relative abundance of Megasphaera genomosp. 1, Atopobium vaginae and Clostridiales sp. (all P<0.05) compared with all other groups. In WLWH, unsuppressed HIV viral loads were associated with a distinct dysbiotic profile consisting of very low levels of Lactobacillus and high levels of anaerobes. Vaginal microbiomes in WLWH with viral load >50copies/ml have distinct dysbiotic profiles with high levels of anaerobes.

The usefulness of HIV partner services in the age of treatment as prevention: a registry-based study

Miami is a Southeastern United States (U.S.) city with high health, mental health, and economic disparities, high ethnic/racial diversity, low resources, and the highest HIV incidence and prevalence in the country. Syndemic theory proposes that multiple, psychosocial comorbidities synergistically fuel the HIV/AIDS epidemic. People living with HIV/AIDS in Miami may be particularly affected by this due to the unique socioeconomic context. From April 2017 to October 2018, 800 persons living with HIV/AIDS in a public HIV clinic in Miami completed an interviewer-administered behavioral and chart-review cross-sectional assessment to examine the prevalence and association of number of syndemics (unstable housing, low education, depression, anxiety, binge drinking, drug use, violence, HIV-related stigma) with poor ART adherence, unsuppressed HIV viral load (≥ 200 copies/mL), and biobehavioral transmission risk (condomless sex in the context of unsuppressed viral load). Overall, the sample had high prevalence of syndemics (M = 3.8), with almost everyone (99%) endorsing at least one. Each syndemic endorsed was associated with greater odds of: less than 80% ART adherence (aOR 1.64, 95% CI 1.38, 1.98); having unsuppressed viral load (aOR 1.16, 95% CI 1.01, 1.33); and engaging in condomless sex in the context of unsuppressed viral load (1.78, 95% CI 1.30, 2.46). The complex syndemic of HIV threatens to undermine the benefits of HIV care and are important to consider in comprehensive efforts to address the disproportionate burden of HIV/AIDS in the Southern U.S. Achieving the 90-90-90 UNAIDS and the recent U.S. "ending the epidemic" targets will require efforts addressing the structural, social, and othersyndemic determinants of HIV treatment and prevention.

Successful navigation of the HIV care continuum is necessary to maintain viral suppression. We explored gender-stratified correlates of being virally unsuppressed in the Prevention for Positives(P4P) component of HPTN 065. The outcome of interest was unsuppressed viral load (> 40 copies/mL) among individuals already living with HIV. Correlatesincluded medication adherence factors, social support and stigma. Logistic regression models were stratified by gender (N = 673). Men-specific correlates of being virally unsuppressed included opposite-sex partners, older age and HIV disclosure stigma. Women-specific correlates included time since diagnosis, and personal-level barriers tomedication adherence. When more individuals knew about their HIV status, women had over twice the likelihood of being virally unsuppressed; no such association was seen among men. Additionally, higher levels of social support were not associated with viral suppression among women. Interventions should consider gender-specific approaches to engaging social support in de-stigmatization of HIV and promotion of medication adherence and subsequentviral suppression.

BackgroundRacial/ethnic inequities along the HIV care continuum persist in the United States despite substantial federal investment. Numerous studies highlight individual and social-level impediments in HIV, but fewer foreground systemic barriers. The present qualitative study sought to uncover and describe systemic barriers to the HIV care continuum from the perspectives of African American/Black and Latino persons living with HIV (PLWH) with unsuppressed HIV viral load, including how barriers operated and their effects.MethodsParticipants were African American/Black and Latino PLWH with unsuppressed HIV viral load (N = 41). They were purposively sampled for maximum variability on key indices from a larger study. They engaged in semi-structured in-depth interviews that were audio-recorded and professionally transcribed. Data were analyzed using directed content analysis.ResultsParticipants were 49 years old, on average (SD = 9), 76% were assigned male sex at birth, 83% were African American/Black and 17% Latino, 34% were sexual minorities (i.e., non-heterosexual), and 22% were transgender/gender-nonbinary. All had indications of chronic poverty. Participants had been diagnosed with HIV 19 years prior to the study, on average (SD = 9). The majority (76%) had taken HIV medication in the six weeks before enrollment, but at levels insufficient to reach HIV viral suppression. Findings underscored a primary theme describing chronic poverty as a fundamental cause of poor engagement. Related subthemes were: negative aspects of congregate versus private housing settings (e.g., triggering substance use and social isolation); generally positive experiences with health care providers, although structural and cultural competency appeared insufficient and managing health care systems was difficult; pharmacies illegally purchased HIV medication from PLWH; and COVID-19 exacerbated barriers. Participants described mitigation strategies and evidenced resilience.ConclusionsTo reduce racial/ethnic inequities and end the HIV epidemic, it is necessary to understand African American/Black and Latino PLWH’s perspectives on the systemic impediments they experience throughout the HIV care continuum. This study uncovers and describes a number of salient barriers and how they operate, including unexpected findings regarding drug diversion and negative aspects of congregate housing. There is growing awareness that systemic racism is a core determinant of systemic barriers to HIV care continuum engagement. Findings are interpreted in this context.