Background
Low-level viremia (LLV) is linked with poor outcomes in persons with HIV. Poor adherence to antiretroviral therapy (ART) is associated with LLV, but other factors may also contribute to LLV. This study aims to identify clinical and programmatic characteristics associated with LLV at the first viral load result post-ART initiation in West Africa.
Methods
We conducted a retrospective cohort analysis of ART initiators (2016-2021) from the International Epidemiology Databases to Evaluate AIDS (IeDEA) West Africa collaboration. First values of viral load (12(±6) months post-ART initiation) were considered in the present analysis to define LLV. The response variable for multinomial regression analysis was viral load categories; primary outcome was LLV, defined as plasma HIV RNA 51- 999 copies/ml. Independent variables included WHO clinical stage at ART initiation, natal sex, initiated on dolutegravir (DTG), and country.
Results
Viral load (VL) results were available for 6367 (51.3%) of 12,398 participants. The cohort (n=6367) was from 7 Programs in 5 West African countries. Most participants were from Ivory Coast (35%) and Benin (34%). Their mean age was 39(SD±11) years, and were predominantly female (60%). At enrolment, 5.4% were at WHO clinical stage 4, one-third were initiated on DTG-based ART. Rates for viral suppression and LLV were 78.7% and 11.3%, respectively. Factors found to be significantly associated with LLV at univariate analysis were male sex (p<.0001), WHO clinical stage (p<.0001), and country (p=0.001). There was a trend toward association for DTG-initiation (p=0.067). Participants at WHO stage 4 compared to WHO stage 1, had 2.044 (1.193, 3.505 p=0.0093) times odds of LLV at first VL result, post ART initiation, when adjusted for DTG initiation, sex, and country.
Conclusions
WHO clinical stage four, male sex and country were found to have statistically significant association with LLV at first VL result. These findings provide critical information for targeted interventions to identify persons at risk of LLV in West Africa and mitigate adverse clinical consequences.
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