Incidences and factors associated with viral suppression or rebound among HIV patients on combination antiretroviral therapy from three counties in Kenya

Abstract

Background: Limited data are available on the incidence and factors associated with viral rebound following viral suppression among HIV-infected individuals taking antiretroviral therapy (ART) in Kenya. Furthermore, the durability of viral suppression among HIV individuals taking ART is unknown. Information on incidence rates and factors associated with HIV viral load rebound and the durability of viral suppression (undetectable HIV copies in plasma) among HIV-infected individuals taking ART, will help improve the long-term management of HIV-infected individuals and explore approaches to longterm HIV remission or complete cure. Objectives: The objectives of this study were to investigate the incidence rates of viral rebound following viral suppression, factors associated with viral rebound, and the durability of viral suppression among HIV-infected individuals on ART from Kilifi, Meru, and Nakuru counties in Kenya. Methods: This was a retrospective study involving 600 HIV-infected individuals taking combination ART (cART) and enrolled in comprehensive care centers (CCCs) at Malindi Sub-county Hospital, Nakuru Level 5 Hospital, and Meru Level 5 Hospital in Kenya. The medical files were inspected and medical history records abstracted for the selected participants. Participant laboratory data including HIV viral loads, types and history of ART, and treatment history of any opportunistic infections were abstracted using an abstraction checklist. Participants were grouped into those who achieved HIV viral suppression, with viral loads lower than the detection limit (LDL) (viral suppression), and those who experienced one or more detectable viral load measurements >40 copies/ml following the initial LDL (viral rebound). Durable viral suppression was defined as all viral load values at LDL over the 2-year period (2017)(2018)(2019). Univariate and multivariate Poisson regression analyses were performed to assess the rates of viral rebound, as well as to investigate factors associated with it. Results: Out of 549 HIV-positive patients, 324/549 (59%) achieved HIV viral suppression (Meru 159/ 194 (82%), Nakuru 21/178 (12%), and Malindi 144/177 (81%)). The overall viral rebound rate was 41%, with site-specific viral rebound of 88.2%, 18.6%, and 18.0% in Nakuru, Malindi, and Meru, respectively. There was an overall rate of first viral rebound of 3.9 (95% confidence interval (CI) 6.9-14.4), 0.7 (95% CI 0.5-1.0), and 0.89 (95% CI 0.64-1.24) per 100 person-months in Nakuru, Malindi, and Meru, respectively. Good ART adherence (p = 0.0002), widow status (p = 0.0062), and World Health Organization (WHO) stage I (p = 0.0002) were associated with viral suppression, while poor ART adherence (p < 0.0001), WHO stage II (p = 0.0024), and duration on ART of 36 months (p = 0.0350) were associated with viral rebound. Conclusions: The rate of viral suppression in patients on cART in the CCCs fell short of the WHO target. However, the study provides proof of evidence of undetectable viral load levels for more than 2 years, a sign that the Un...

Virological Suppression and Its Associated Factors of Dolutegravir Based Regimen in a Resource-Limited Setting: An Observational Retrospective Study in Ethiopia

“…In this study, the virological suppression was about six times higher among participants with good adherence as compared to participants with poor adherence. This result is in line with Ethiopian studies 28 , 29 and a Kenyan study 30 done on other ART regimens where good adherence was a significant predictor of viral load suppression. This association was also reported by other similar studies.…”

HIV care cascade among cisgender men who have sex with men in a key population-led community center in the Philippines

“…[69][70][71][72] Second, having AIDS-related manifestations was also associated with a lower probability of starting ART. 6,73 Our findings from the multivariate analyses emphasize the significance of early diagnosis and early ART initiation to achieve both clinical and public health benefit.…”

Virological Non-Suppression Among HIV-Positive Patients on Antiretroviral Therapy in Northwestern Nigeria: An Eleven-Year Experience of A Tertiary Care Centre, January 2009–December 2019

“…The high levels of viral suppression observed in this study compared to the other studies may be due to several reasons; for instance, the cut off used for the viral suppression in our study was VL < less 1000 compared with a low value of 400 used in the earlier Nigeria study that evaluated viral suppression after test and treat protocols [8] and after six months of initiation of first-line of HAART in a Moroccan study [15]. Besides, our centre is also a tertiary health care centre with a dedicated unit for PLHIV and patients routinely undergo adherence counselling during their clinic visits which could have enhanced their compliance with their medications [16]. Our findings also suggest that the goal of achieving a 90% level of viral suppression is achievable in a resource-limited country like ours and the current approach in the management of HIV should be sustained.…”