What affects viral suppression in women with HIV on ART?

Food insecurity, drug resistance, and nondisclosure of status are all important predictors of virologic nonsuppression among women with HIV on antiretroviral therapy (ART), a recent study has found.

Researchers enrolled 470 women (median age 28 years) who had been on ART for ≥4 months. Most (86.0 percent) were married or cohabitating, and 26.0 percent (n=122) reported at least mild depressive symptoms. Almost all (96.6 percent) disclosed their HIV status and 90.1 percent reported disclosure to their partners.

Fifty-seven participants (12.1 percent) showed viral loads ≥1,000 copies/mL, indicative of nonsuppression. Fifty-four were subsequently tested for drug resistance, of whom 35 (64.8 percent) harboured such mutations conferring resistance against non-nucleoside reverse transcriptase inhibitors and nucleoside/tide reverse transcriptase inhibitors.

Aside from drug resistance mutations, multivariate analysis found that food insecurity significantly increased the risk of virologic nonsuppression (adjusted relative risk [RR], 2.07, 95 percent confidence interval [CI], 1.15–3.72; p=0.02). In contrast, disclosure of HIV status significantly improved suppression (aRR, 0.34, 95 percent CI, 0.15–0.78; p=0.01).

ART adherence (RR, 0.67, 95 percent CI, 0.46–0.98; p=0.04), particularly the level of behavioural skills to adhere to medication (RR, 0.70, 95 percent CI, 0.58–0.85; p<0.001), were associated with better virological suppression in univariate analysis, but were attenuated after multivariate adjustment.

“We found that virologic nonsuppression among pregnant women living with HIV on ART was more frequent among women who had not disclosed their HIV status, were food insecure, or had lower adherence behavioural skills,” the researchers said. “Addressing these factors may improve viral suppression among pregnant women.”