Abstract
Background
Achieving undetectable viral loads is crucial for the reduction of HIV transmissions, AIDS related illnesses and death. Adolescents living with HIV on antiretroviral therapy (ART) have worse treatment adherence and lower viral suppression rates compared to adults. We report on the clinical factors associated with viral suppression among adolescents 10–19 years living with HIV in the Ehlanzeni district, Mpumalanga in South Africa.
Methods
A retrospective cohort analysis was conducted with 9,543 adolescents living with HIV, aged 10–19 years, who were enrolled in 136 ART clinics in the Ehlanzeni district. Clinical and immunological data were obtained from electronic medical records (Tier.net). Adolescents were categorized as having achieved viral suppression if their latest viral load count was < 1000 ribonucleic acid (RNA) copies/mL. Using a backward stepwise approach, a multivariate logistic regression analysis was performed to identify factors independently associated with viral suppression.
Results
The mean age of the participants was 14.75 years (SD = 2.8), and 55.43% were female. Mean duration on ART was 72.26 (SD = 42.3) months. Of the 9,543 adolescents with viral load results recorded, 74% had achieved viral suppression. After adjusting for other covariates, the likelihood of achieving viral suppression remained significantly higher among adolescents who were: female (AOR = 1.21, 95% CI 1.05–1.38), had CD4 count > 200 (AOR = 2.29, 95% CI 1.89–2.79), and on ART for more than 6 months (AOR = 2.75, 95% CI 1.74–4.34). Furthermore, the likelihood of having viral suppression was lower among adolescents with CD4 count < 200 at baseline (AOR = 0.76, 95% CI 0.64–0.90), and who were switched to second line regimen (AOR = 0.42, 95% CI 0.35–0.49).
Conclusions
Viral suppression amongst adolescents at 74% is considerably lower than the WHO target of 90%. Of particular concern for intervention is the lower rates of viral suppression amongst male adolescents. Greater emphasis should be placed to enrol adolescents on ART earlier before CD4 counts are depleted (< 200) and keeping them engaged in care (beyond 6 months). Furthermore, improved viral load monitoring may prevent unnecessary switching to second line treatment, which are costly and is a risk factor for viral non suppression.
Is PrEP necessary during natural conception in HIV-1-serodiscordant couples on ART with suppressed viral load? A retrospective cohort analysis