Background
Data from national programs are key to evaluate antiretroviral therapy (ART) virologic effectiveness in real-life settings, especially in people with HIV (PWH) receiving treatment for tuberculosis (TB) . The objective of the present study was to evaluate factors associated with virologic suppression within the Brazilian national HIV/TB program.
Methods
A retrospective cohort study was conducted from January 2016 to June 2022, including all adult Brazilian PWH who started ART within 5 months before and 6 months after TB diagnosis. We excluded participants without HIV-1 RNA available. Virologic success was defined as HIV-1 RNA< 50 copies/mL 1 year after ART initiation (window 9-18 months). We assessed determinants of virologic suppression using a multivariate logistic regression analysis.
Results
13,997 PWH treated for tuberculosis were included in the present analysis. At ART initiation, median age was 36 (IQR: 29-45) years and 21.7% were females; median CD4+ T-cell count and HIV-1 RNA were 125 (IQR: 48-278) cells/mm3 and 5.1 (IQR 4.2-5.7) log10 copies/mL, respectively.
6,531/13,997 (46.7%) participants started dolutegravir, 2,439/13,997 (17.4%) raltegravir, 4694/13,997 (33.5%) efavirenz. One year after ART initiation, 8,206/13,997 (58.6%) participants achieved virologic suppression overall. In the multivariate analysis, TB diagnosis before ART initiation (OR=1.37; 95%CI:1.06-1.77), higher CD4+ T-cell count (CD4≥350/mm3) (OR=1.81; 95%CI:1.55-2.13), HIV-1 RNA <100,000 copies/mL (OR= 1.57; 95%CI:1.38-1.79) and dolutegravir use (OR=1.25; 95%CI:1.11-1.40) were all positively associated to virologic suppression. Factors that were negatively associated to virologic suppression were younger age (18-24 years) (OR=0.79; 95% CI: 0.68-0.93), male sex (OR=0.86; 95%CI: 0.76-0.97) and lower educational level (less than 9 years of schooling) (OR=0.71; 95%CI: 0.64; 0.79).
Conclusions
In this analysis from the Brazilian national HIV/TB program, we found that initiating dolutegravir-based regimen was associated with virologic suppression 1 year after ART initiation in PWH treated for TB. Markers of HIV advanced disease and social vulnerability were negatively associated with ART effectiveness, which emphasizes the need to offer person-centred interventions to most vulnerable populations.