Behavioral and Other Characteristics Associated with HIV Viral Load in an Outpatient Clinic

Abstract

Persons living with HIV (PLWH) who are engaged in care, yet not virally suppressed, represent a risk for transmission and opportunity for risk reduction interventions. This study describes characteristics of an outpatient clinic cohort of PLWH by laboratory confirmed viral suppression status and examines associations with demographics and sexual and drug use behaviors gathered through questionnaire. From a sample of 500 clinic patients, 438 were prescribed antiretroviral treatment (ART) and 62 were not. Among the 438 on ART, 72 (16.4%) were not virally suppressed at the most recent lab draw. Compared to individuals with a suppressed viral load, those that were unsuppressed were more likely to: be black (79.2% vs. 64.2%; p = 0.014); earn below $25,000/year (88.9% vs. 65.0%; p < 0.001); be of a younger age (47.8 vs. 50.0 mean years; p = 0.009); be on opiate substitution (14.1% vs. 6.3%; p = 0.023); and acknowledge poly-substance (38.9% vs. 24.4%; p = 0.012) and excessive alcohol use (13.9% vs. 6.0%; p = 0.019). Conversely, a smaller proportion of those with an unsuppressed viral load had multiple sex partners in the previous 30 days (39.8% vs. 58.5%; p = 0.003). In multivariable regression of those on ART, the prevalence of an unsuppressed viral load was 3% lower with each increasing year of age (aPR: 0.97; 95% CI: 0.95, 0.99) and 47% lower with income over $25,000/year (aPR: 0.33; 95% CI: 0.16, 0.70). In a separate analysis of all 500 subjects, ART was less frequently prescribed to blacks compared to whites, heterosexuals, those with lower education and income, and persons with active substance use. Findings confirm that a large proportion of PLWH and engaged in care were not virally suppressed and continued behaviors that risk transmission, indicating the need for screening, prevention counseling and access to ancillary services to lower the incidence of HIV infections.

Magnitude of virologic failure and associated factors among adult patients on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia, 2018

“…In agreement with previous studies [32,[35][36][37][38][39][40][41][42], the current study found baseline non-working functional status, low CD4 cell count, advanced WHO clinical stage, and presence of opportunistic infections leads to ART virological failure. Despite this fact, these risk factors are highly interconnected, CD4 cell count is the backbone of immunity construction that helps the human body to protect from the disease and can prevent HIV replication [44].…”

“…Social support, such as someone to help with the tasks of starting to rebuild a life, assistance with cooking and assistance to grow crops, all encouraged ART adherence, prevention of opportunistic infections and reduction of viral replication and finally better treatment outcome [33,34,39]. Similarly, it has been reported in other study [40] as social support was a constant predictor of could virological suppression because it help to avoid risky daily behaviors and activities of the patient.…”

“…This might be due to the fact that those worker patients may have better income that in turn creates opportunity to get better care and support. This finding could also be explained as patients who were unable to work might be in their advanced WHO stage of the disease aggravated from greater immunosuppression (low CD4 count) [5,13,44] or they might be depressed, feel hopelessness which might in turn lead to poor drug adherence then virological or in general treatment failure [37][38][39][40]. .…”

“…It had been evidenced that CD4 count has an inverse relationship with viral replication and load. That is, as patients' immune status becomes compromised (low CD4 count), the rate of viral replication increases compared to their immunecompetent counterparts [3,40,44]. Furthermore, clients with compromised immunity are more vulnerable to different opportunistic infections that sustain the vicious cycle of immunity and viral replication [44].…”

Regional differences between people who inject drugs in an HIV prevention trial integrating treatment and prevention (HPTN 074): a baseline analysis

“…Additionally, methadone, home‐made opioids and amphetamines were the predominant injected substances. The extensive use of varying types of substances, may delay engagement and hinder benefits of HIV and substance use treatment among PWID .…”