Abstract
Background: Human immunodeficiency virus infection remains a public health challenge, mostly in sub-Saharan Africa. This region accounts for 65% of those infected and contributes to 50% of new infections. The World Health Organization advocates for early antiretroviral therapy (ART) initiation for all newly diagnosed individuals. If monitoring viral load (VL) after ART initiation is increasingly common, baseline VL testing is under-utilized in resource-limited settings. However, it is known that the baseline HIV viral load significantly influences the likelihood of achieving virological suppression in individuals starting antiretroviral therapy. The aim of this study was to investigate the immunological and virological profile of people living with HIV (PLWHIV) and associated factors at the initiation of ART.
Methods: We performed a retrospective analysis of data from an open cohort of PLWHIV followed at the Souro SANOU University Hospital adult day hospital who initiated antiretroviral therapy between January 2011 to October 2017. The analysis included patients who had a baseline HIV-1 viral load before ART initiation.
Results: There were 295 PLWHIV included, 67.1% of whom were female, and the median age was 39 years. The median viral load was 252,385 (IQR: 56,023-847,910) copies/mL and the median CD4 T cell count was 177 cells/μL (IQR:70–296). PLWHIV with baseline HIV-1 RNA >100,000 copies/mL and CD4+ count <200 cells/µL were respectively 66.8% and 57.9%. In logistic regression multivariate analysis, WHO clinical stage 3 (Adjusted Odds Ratio (AOR): 2.3 (95%CI 1.25–4.35)), stage 4 (AOR: 4.5 (95%CI 1.45–13.87)), viral load between 100,000–1,000,000 (AOR: 4.2 (95%CI 1.66–10.66)), and above 1,000,000 (AOR: 5.3 (95%CI 1.90–14.76)) were associated with immunosuppression. Regarding viremia, clinical suspicion as a circumstance for HIV diagnosis (AOR: 2.4 (95%CI 1.16–5.19)), WHO clinical stage 4 (AOR: 3.3 (95%CI 1.11–9.61)) were associated with a viremia above 1,000,000 copies/mL.
Conclusions: Regular monitoring of follow-up data would enable us to understand the factors associated with late presentation to HIV/AIDS services and to design effective treatment programs and strategies to meet UNAIDS targets.
Keywords
HIV, Immunological, Virological, Late presentation, Burkina Faso