Factors associated with lack of viral suppression in human immunodeficiency virus-infected male patients treated with anti-retroviral therapy at Bach Mai hospital, Hanoi

Authors

  • Hanh Tran Thi Duc Department of Epidemiology, Hanoi University of Public Health, Hanoi, Vietnam
  • Thanh Thi Dinh Nanogen Pharmaceutical Biotechnology JSC, Hochiminh City, Vietnam
  • Cuong Duy Do Centre for Tropical Disease, Bach Mai Hospital, Hanoi, Vietnam
  • Ha Thi Nguyen University of Education, Vietnam National University, Vietnam
  • Linh Vu Phuong Dang Lysosomal Health in Aging, SAHMRI, Australia

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20250299

Keywords:

HIV infection, Vietnam, CD4 T cell counts, Opportunistic infection, Tuberculosis, Lack of viral suppression

Abstract

Background: Viral suppression following anti-retroviral therapy (ART) is one of the most effective factors determining human immunodeficiency virus (HIV) treatment success. However, certain numbers of HIV-infected patients do not experience viral suppression despite ART initiation, which ultimately might lead to treatment failure.

Method: A cross-sectional study was conducted including 194 male patients enrolled at the out-patient clinic, centre for tropical diseases, Bach Mai hospital, Vietnam. Data was analyzed using Stata 12.0.20 for Man-Whitney, Chi-square test/ Fisher’s exact test, and multivariable logistic regression with statistically significant p<0.05.

Results: The results show that being men who have sex with men (aOR=12.14, 95% CI: 1.48-99.49), having low CD4 T cell counts (aOR=269.58, 95% CI: 4.94-14721.27), living in rural areas (aOR=4.63, 95% CI: 1.04-20.57), and not having preventive tuberculosis treatment (aOR=9.92, 95% CI: 1.17-84.10), have increased odds of having detectable viral loads (VL). On the contrary, opportunistic infection was negatively associated with a lack of viral suppression (aOR=0.21, 95% CI: 0.05-0.96).

Conclusions: The results suggest that intervention programs should focus on patients living in rural areas, having low CD4 T cell counts, acquiring opportunistic infection, and MSM patients.

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References

The Global HIV/AIDS Epidemic. In: Services tUSDoHH, editor. 2021. Available at: https://www.hiv.gov/. Accessed on 14 November 2024.

Global HIV and AIDS statistics-Fact sheet. 2019. Available at: https://www.unaids.org/en/resources/fact-sheet. Accessed on 14 November 2024.

UNAIDS Data 2019. 2019. Available at: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwijmeHF-d3zAhUaat4KHZQkC3QQFnoECBQQAQ&url=https%3A%2F%2Fwww.unaids.org%2Fsites%2Fdefault%2Ffiles%2Fmedia_asset%2F2019-UNAIDS-data_en.pdf&usg=AOvVaw0PCW-o9HtZpIZRJ41Lqll7. Accessed on 14 November 2024

AIDSinfo. Updated. 2019. Available at: https://aidsinfo.unaids.org/. Accessed on 14 November 2024.

Number of new HIV infections. 2021. Available at: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/number-of-new-hiv-infections. Accessed on 14 November 2024.

Mellors JW, Rinaldo CR Jr, Gupta P, White RM, Todd JA, Kingsley LA. Prognosis in HIV-1 infection predicted by the quantity of virus in plasma. Science. 1996;272(5265):1167-70. DOI: https://doi.org/10.1126/science.272.5265.1167

Miller V, Phillips AN, Clotet B, Mocroft A, Ledergerber B, Kirk O, et al. Association of virus load, CD4 cell count, and treatment with clinical progression in human immunodeficiency virus-infected patients with very low CD4 cell counts. J Infect Dis. 2002;186(2):189-97. DOI: https://doi.org/10.1086/341466

Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. The New England journal of medicine. 2011;365(6):493-505. DOI: https://doi.org/10.1056/NEJMoa1105243

Control VNAfA. HIV/AIDS care and treatment guidelines. In: Vietnam MoH, editor. 2019.

Qiu T, Ding P, Fu G, Huan X, Xu X, Zhang Z, et al. Immunologic treatment failure among HIV-infected adult patients in Jiangsu province, China. Sci Rep. 2017;7:42381. DOI: https://doi.org/10.1038/srep42381

Samizi FG, Panga OD, Mulugu SS, Gitige CG, Mmbaga EJ. Rate and predictors of HIV virological failure among adults on first-line antiretroviral treatment in Dar Es Salaam, Tanzania. J Infect Develop Countries. 2021;15(6):853-60. DOI: https://doi.org/10.3855/jidc.13603

De La Hoz JM, Bolano L, Cardenas O, Gonzalez R, Sabbag J, Palacio L, et al. Characterization of treatment failure in HIV positive patients in the Colombian Caribbean region. Colomb Med (Cali). 2014;45(4):162-7. DOI: https://doi.org/10.25100/cm.v45i4.1566

Pollack TM, Duong HT, Pham TT, Do CD, Colby D. Cigarette smoking is associated with high HIV viral load among adults presenting for antiretroviral therapy in Vietnam. PLoS One. 2017;12(3):e0173534. DOI: https://doi.org/10.1371/journal.pone.0173534

Donnelly CA, Bartley LM, Ghani AC, Le Fevre AM, Kwong GP, Cowling BJ, et al. Gender difference in HIV-1 RNA viral loads. HIV Med. 2005;6(3):170-8. DOI: https://doi.org/10.1111/j.1468-1293.2005.00285.x

Natural History Project Working Group for the Collaboration of Observational HIVEREiE. Factors associated with short-term changes in HIV viral load and CD4(+) cell count in antiretroviral-naive individuals. Aids. 2014;28(9):1351-6. DOI: https://doi.org/10.1097/QAD.0000000000000224

Novitsky V, Gilbert P, Peter T, McLane MF, Gaolekwe S, Rybak N, et al. Association between virus-specific T-cell responses and plasma viral load in human immunodeficiency virus type 1 subtype C infection. J Virol. 2003;77(2):882-90. DOI: https://doi.org/10.1128/JVI.77.2.882-890.2003

Brown ER, Otieno P, Mbori-Ngacha DA, Farquhar C, Obimbo EM, Nduati R, et al. Comparison of CD4 cell count, viral load, and other markers for the prediction of mortality among HIV-1-infected Kenyan pregnant women. J Infect Dis. 2009;199(9):1292-300. DOI: https://doi.org/10.1086/597617

Joseph Davey D, Abrahams Z, Feinberg M, Prins M, Serrao C, Medeossi B, et al. Factors associated with recent unsuppressed viral load in HIV-1-infected patients in care on first-line antiretroviral therapy in South Africa. Int J STD AIDS. 2018;29(6):603-10. DOI: https://doi.org/10.1177/0956462417748859

Das M, Chu PL, Santos GM, Scheer S, Vittinghoff E, McFarland W, et al. Decreases in community viral load are accompanied by reductions in new HIV infections in San Francisco. PLoS One. 2010;5(6):e11068. DOI: https://doi.org/10.1371/journal.pone.0011068

Ellen JM, Kapogiannis B, Fortenberry JD, Xu J, Willard N, Duval A, et al. HIV viral load levels and CD4+ cell counts of youth in 14 cities. Aids. 2014;28(8):1213-9. DOI: https://doi.org/10.1097/QAD.0000000000000183

Hollingsworth TD, Pilcher CD, Hecht FM, Deeks SG, Fraser C. High Transmissibility During Early HIV Infection Among Men Who Have Sex With Men-San Francisco, California. J Infect Dis. 2015;211(11):1757-60. DOI: https://doi.org/10.1093/infdis/jiu831

Yeghiazarian L, Cumberland WG, Yang OO. A stochastic multi-scale model of HIV-1 transmission for decision-making: application to a MSM population. PLoS One. 2013;8(11):e70578. DOI: https://doi.org/10.1371/journal.pone.0070578

Dimitrov D, Wood D, Ulrich A, Swan DA, Adamson B, Lama JR, et al. Projected effectiveness of HIV detection during early infection and rapid ART initiation among MSM and transgender women in Peru: A modeling study. Infect Dis Model. 2019;4:73-82. DOI: https://doi.org/10.1016/j.idm.2019.04.001

Stirratt MJ, Marks G, O'Daniels C, Cachay ER, Sullivan M, Mugavero MJ, et al. Characterising HIV transmission risk among US patients with HIV in care: a cross-sectional study of sexual risk behaviour among individuals with viral load above 1500 copies/mL. Sex Transm Infect. 2018;94(3):206-11. DOI: https://doi.org/10.1136/sextrans-2017-053178

Donovan RM, Bush CE, Markowitz NP, Baxa DM, Saravolatz LD. Changes in virus load markers during AIDS-associated opportunistic diseases in human immunodeficiency virus-infected persons. J Infect Dis. 1996;174(2):401-3. DOI: https://doi.org/10.1093/infdis/174.2.401

Shoko C, Chikobvu D. A superiority of viral load over CD4 cell count when predicting mortality in HIV patients on therapy. BMC Infect Dis. 2019;19(1):169. DOI: https://doi.org/10.1186/s12879-019-3781-1

Hunt PW, Martin JN, Sinclair E, Bredt B, Hagos E, Lampiris H, et al. T cell activation is associated with lower CD4+ T cell gains in human immunodeficiency virus-infected patients with sustained viral suppression during antiretroviral therapy. J Infect Dis. 2003;187(10):1534-43. DOI: https://doi.org/10.1086/374786

Lederman MM, Funderburg NT, Sekaly RP, Klatt NR, Hunt PW. Residual immune dysregulation syndrome in treated HIV infection. Adv Immunol. 2013;119:51-83. DOI: https://doi.org/10.1016/B978-0-12-407707-2.00002-3

Lederman MM, Calabrese L, Funderburg NT, Clagett B, Medvik K, Bonilla H, et al. Immunologic failure despite suppressive antiretroviral therapy is related to activation and turnover of memory CD4 cells. J Infect Dis. 2011;204(8):1217-26. DOI: https://doi.org/10.1093/infdis/jir507

Buzon MJ, Massanella M, Llibre JM, Esteve A, Dahl V, Puertas MC, et al. HIV-1 replication and immune dynamics are affected by raltegravir intensification of HAART-suppressed subjects. Nat Med. 2010;16(4):460-5. DOI: https://doi.org/10.1038/nm.2111

Chadha S, Bhalla P, Jha AK, Gautam H, Saini S, Anuradha S, et al. Disease progression and antiretroviral therapy in newly seropositive HIV subjects in a tertiary care hospital in North India. J Infect Develop Countries. 2013;7(2):110-5. DOI: https://doi.org/10.3855/jidc.2875

Dang LVP, Nguyen QH, Ishizaki A, Larsson M, Vu NTP, Do Duy C, et al. Prevalence of Opportunistic Infections and Associated Factors in HIV-Infected Men Who Have Sex With Men on Antiretroviral Therapy in Bach Mai Hospital, Hanoi, Vietnam: A Case-Control Study. Am J Mens Health. 2020;14(3):1557988320926743. DOI: https://doi.org/10.1177/1557988320926743

Tran NB, Houben RM, Hoang TQ, Nguyen TN, Borgdorff MW, Cobelens FG. HIV and tuberculosis in Ho Chi Minh City, Vietnam, 1997-2002. Emerg Infect Dis. 2007;13(10):1463-9. DOI: https://doi.org/10.3201/eid1309.060774

Komati S, Shaw PA, Stubbs N, Mathibedi MJ, Malan L, Sangweni P, et al. Tuberculosis risk factors and mortality for HIV-infected persons receiving antiretroviral therapy in South Africa. Aids. 2010;24(12):1849-55. DOI: https://doi.org/10.1097/QAD.0b013e32833a2507

El-Khatib Z, Ekstrom AM, Ledwaba J, Mohapi L, Laher F, Karstaedt A, et al. Viremia and drug resistance among HIV-1 patients on antiretroviral treatment: a cross-sectional study in Soweto, South Africa. Aids. 2010;24(11):1679-87. DOI: https://doi.org/10.1097/QAD.0b013e32833a097b

Ahoua L, Guenther G, Pinoges L, Anguzu P, Chaix ML, Le Tiec C, et al. Risk factors for virological failure and subtherapeutic antiretroviral drug concentrations in HIV-positive adults treated in rural North-Western Uganda. BMC Infect Dis. 2009;9:81. DOI: https://doi.org/10.1186/1471-2334-9-81

Gupta A, Wood R, Kaplan R, Bekker LG, Lawn SD. Prevalent and incident tuberculosis are independent risk factors for mortality among patients accessing antiretroviral therapy in South Africa. PLoS One. 2013;8(2):e55824. DOI: https://doi.org/10.1371/journal.pone.0055824

Goletti D, Weissman D, Jackson RW, Graham NM, Vlahov D, Klein RS, et al. Effect of Mycobacterium tuberculosis on HIV replication. Role of immune activation. J Immunol. 1996;157(3):1271-8. DOI: https://doi.org/10.4049/jimmunol.157.3.1271

Bulage L, Ssewanyana I, Nankabirwa V, Nsubuga F, Kihembo C, Pande G, et al. Factors Associated with Virological Non-suppression among HIV-Positive Patients on Antiretroviral Therapy in Uganda, August 2014-July 2015. BMC Infect Dis. 2017;17(1):326. DOI: https://doi.org/10.1186/s12879-017-2428-3

Musiime V, Kayiwa J, Kiconco M, Tamale W, Alima H, Mugerwa H, et al. Response to antiretroviral therapy of HIV type 1-infected children in urban and rural settings of Uganda. AIDS Res Hum Retroviruses. 2012;28(12):1647-57. DOI: https://doi.org/10.1089/aid.2011.0313

Etta EM, Mavhandu L, Manhaeve C, McGonigle K, Jackson P, Rekosh D, et al. High level of HIV-1 drug resistance mutations in patients with unsuppressed viral loads in rural northern South Africa. AIDS Res Ther. 2017;14(1):36. DOI: https://doi.org/10.1186/s12981-017-0161-z

Parker RD, Mangine CM, Hendricks BM, Cima MJ, Mcie S, Sarwari A. Adherence to HIV Treatment and Care at a Rural Appalachian HIV Clinic. J Assoc Nurses AIDS Care. 2017;28(1):67-74. DOI: https://doi.org/10.1016/j.jana.2016.09.002

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Published

2025-01-31

How to Cite

Thi Duc, H. T., Thi Dinh, T., Duy Do, C., Nguyen, H. T., & Vu Phuong Dang, L. (2025). Factors associated with lack of viral suppression in human immunodeficiency virus-infected male patients treated with anti-retroviral therapy at Bach Mai hospital, Hanoi. International Journal Of Community Medicine And Public Health, 12(2), 694–701. https://doi.org/10.18203/2394-6040.ijcmph20250299

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Original Research Articles