Factors associated with viremia in people living with HIV on antiretroviral therapy in Guatemala

• Published in: AIDS research and therapy Vol. 18; no. 1; pp. 1 - 79
• Main Authors: Ortíz, Dean W, Roberts-Sano, Olivia, Marroquin, Hugo E, Larson, Lindsey, Franco, Katherine B, Spec, Andrej, Melendez, Johanna R, Pinzón, Rodolfo, Samayoa, Ana J, Mejia-Chew, Carlos, O´Halloran, Jane A
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 27.10.2021; BioMed Central; BMC
• Subjects: Acquired immune deficiency syndrome; AIDS; Alcohol; Alcoholic beverages; Analysis; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Care and treatment; CD4 antigen; Confidence intervals; Demographic aspects; Diagnosis; Disease transmission; Drug therapy; Education; Enrollments; Gender; Health behavior; Health care; Health risk behavior; Health services; Health services accessibility; HIV; HIV patients; Human immunodeficiency virus; Immunosuppression; Men; Methods; Risk factors; Socioeconomics; Statistical analysis; Sustained virologic suppression; Treatment outcomes; Variables; Viremia; Guatemala; Latin America
• ISSN: 1742-6405; 1742-6405
• DOI: 10.1186/s12981-021-00400-9

Introduction Viral suppression prevents HIV transmission and disease progression, but socio-economic and clinical factors can hinder the goal of suppression. We evaluated factors associated with viral non suppression (VNS) and persistent viremia (PV) in people living with HIV (PLHIV) receiving antiretroviral therapy (ART) in Guatemala. Methods We conducted a cross sectional analysis using data from an ongoing cohort of PLHIV attending the largest HIV clinic in Guatemala. Univariable and multivariable analyses were conducted between PLHIV with viral suppression and detectable viremia. VNS was defined as most recent HIV RNA [greater than or equai to] 200 copies/ml and PV as two consecutive HIV RNA [greater than or equai to] 200 copies/ml. Results Of 664 participants, 13.3% had VNS and 7.1% had PV. In univariable analysis disaggregated by gender, low income, poor education, perceived difficulty attending healthcare, and alcohol use were associated with VNS in men while low CD4 at diagnosis, multiple prior ART regimens and treatment interruptions were significant in both genders. Multiple prior ART regimens (adjusted Odds Ratio (aOR) 2.82, [95% confidence interval (CI) 1.59, 4.99], p < 0.01), treatment interruptions (aOR 4.51, [95% CI 2.13, 9.58], p < 0.01), excessive alcohol consumption (aOR 2.56, [95% CI 1.18, 5.54], p < 0.05) perceived difficulty attending healthcare (aOR 2.07, [ 95% CI 1.25, 3.42], p < 0.01) and low CD4 at diagnosis (aOR 2.34, 95% [CI 1.30, 4.20], p < 0.01) were independently associated with VNS on multivariable regression. Conclusions We conclude that socio-economic and clinical factors influence viral suppression in our cohort and vary between men and women. Gender specific approaches are necessary to achieve the 90% suppression goal. Keywords: HIV, Treatment outcomes, Health risk behavior, Health services accessibility, Sustained virologic suppression, Gender