Detectable viral loads persist in one-third of PLHIV in Asia-Pacific region

Between 2015 and 2020, nearly a third of people living with HIV (PLHIV) in Asia-Pacific countries still show a detectable viral load, according to a study presented at the HIV Glasgow 2022 Congress.

This finding suggests the importance of maintaining life-long adherence counseling and follow-up, especially among PLHIV with a higher likelihood of having detectable viral load.

“A proportion of PLHIV continue to have detectable viral load while on robust antiretroviral therapy (ART) regimens, thus, persist to have the risk of onward HIV transmission,” said the researchers, led by Maylin Palatino, research associate at the Diagnostic Radiology and Nuclear Medicine of the University of Maryland School of Medicine, Columbia, SC, US.

Palatino and her colleagues from countries including the Philippines, Thailand, Indonesia, Malaysia, Vietnam, Cambodia, and Singapore, among others in the Asia-Pacific region, sought to determine the proportion of and factors associated with having a detectable VL from 2015 to 2020.

A total of 20,765 adult PLHIV enrolled in the TREAT Asia HIV Observational Database (TAHOD) and TAHOD Low Intensity Transfer (TAHOD-LITE) cohorts of IeDEA Asia-Pacific on ART for ≥1 year, in follow-up between 2015 and 2020, and with ≥1 viral load measurement during the follow-up period, were included in this analysis.

A detectable viral load was characterized by having at least one viral load measured ≥50 copies/mL between 2015 and 2020. The researchers then used repeated measures logistic regression to evaluate the factors associated with detectable viral load.

Of the PLHIV who met the eligibility criteria, 64 percent were male and 72 percent had heterosexual contact as their mode of HIV exposure. [HIV Glasgow 2022, abstract P230]

About one in three PLHIV (n=6,038, 29 percent) had ≥1 detectable viral load from 2015 to 2020. Of these individuals, 2,881 (48 percent) had viral load measurements between 50 and <200 copies/mL, 684 (11 percent) between 200 and <1,000 copies/mL, 495 (8 percent) between 1,000 and <5,000 copies/mL, and 1,978 (33 percent) at least 5,000 copies/mL.

The following factors were significantly associated with a lower likelihood of having detectable viral load: female sex (odds ratio [OR], 0.84, 95 percent confidence interval [CI], 0.78‒0.90) compared to males, older age (31 to 40 years: OR, 0.68, 95 percent CI, 0.61‒0.77; 41 to 50 years: OR, 0.56, 95 percent CI, 0.50‒0.631; ≥51 years: OR, 0.44, 95 percent CI, 0.39‒0.05) compared to ≤30 years, and male-to-male sex (OR, 0.87, 95 percent CI, 0.77‒0.98) and injecting drug use (OR, 0.66, 95 percent CI, 0.52‒0.83) compared to heterosexual contact as mode of HIV exposure.

Adult PLHIV receiving non-nucleoside reverse transcriptase inhibitor-based ART (OR, 0.48, 95 percent CI, 0.44‒0.52) compared to integrase strand transfer inhibitor (INSTI)-based regimens were also less likely to have a detectable viral load.

Of note, “detectable viral load was more likely among those on protease inhibitor-based ART regimens (OR, 1.54, 95 percent CI, 1.40‒1.69) compared to INSTI-based ART,” the researchers said.

Other factors contributing to decreased odds of having a detectable viral load were hepatitis B coinfection (OR, 0.80, 95 percent CI, 0.70‒0.92), hepatitis C coinfection (OR, 0.82, 95 percent CI, 0.69‒0.97), higher CD4 count (200 to 350 cells/μL: OR, 0.34, 95 percent CI, 0.30‒0.38; 351 to 500 cells/μL: OR, 0.20, 95 percent CI, 0.18‒0.23; >500 cells/μL: OR, 0.16, 95 percent CI, 0.15‒0.18) compared to CD4 <200 cells/μL, and higher vs lower-middle country income (upper-middle: OR, 0.22, 95 percent CI, 0.20‒0.24; high: OR, 0.36, 95 percent CI, 0.32‒0.41).