Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
Department of National Health Laboratory Services, Ministry of Health, Kampala Uganda.
PLoS One. 2023 Jan 13;18(1):e0279479. doi: 10.1371/journal.pone.0279479. eCollection 2023.
Uganda's efforts to end the HIV epidemic by 2030 are threatened by the increasing number of PLHIV with low-level viraemia (LLV). We conducted a study to determine the prevalence of LLV and the association between LLV and subsequent viral non-suppression from 2016 to 2020 among PLHIV on ART in Uganda.
This was a retrospective cohort study, using the national viral load (VL) program data from 2016 to 2020. LLV was defined as a VL result of at least 50 copies/ml, but less than 1,000 copies/ml. Multivariable logistic regression was used to determine the factors associated with LLV, and cox proportional hazards regression model was used to determine the association between LLV and viral non-suppression.
A cohort of 17,783 PLHIV, of which 1,466 PLHIV (8.2%) had LLV and 16,317 (91.8%) had a non-detectable VL was retrospectively followed from 2016 to 2020. There were increasing numbers of PLHIV with LLV from 2.0% in 2016 to 8.6% in 2020; and LLV was associated with male sex, second line ART regimen and being of lower age. 32.5% of the PLHIV with LLV (476 out of 1,466 PLHIV) became non-suppressed, as compared to 7.7% of the PLHIV (1,254 out of 16,317 PLHIV) with a non-detectable viral load who became non-suppressed during the follow-up period. PLHIV with LLV had 4.1 times the hazard rate of developing viral non-suppression, as compared to PLHIV with a non-detectable VL (adjusted hazard ratio was 4.1, 95% CI: 3.7 to 4.7, p < 0.001).
Our study indicated that PLHIV with LLV increased from 2.0% in 2016 to 8.6% in 2020, and PLHIV with LLV had 4.1 times the hazard rate of developing viral non-suppression, as compared to PLHIV with a non-detectable VL. Hence the need to review the VL testing algorithm and also manage LLV in Uganda.
乌干达力争在 2030 年终结艾滋病毒流行，但不断增加的艾滋病毒感染者（PLHIV）出现低水平病毒血症（LLV），这一目标受到威胁。本研究旨在确定 2016 年至 2020 年期间，乌干达接受抗逆转录病毒治疗（ART）的 PLHIV 中 LLV 的流行率，以及 LLV 与随后病毒抑制失败之间的关联。
这是一项回顾性队列研究，使用了 2016 年至 2020 年全国病毒载量（VL）监测项目的数据。将 VL 至少为 50 拷贝/ml 但小于 1000 拷贝/ml 的情况定义为 LLV。多变量逻辑回归用于确定与 LLV 相关的因素，Cox 比例风险回归模型用于确定 LLV 与病毒抑制失败之间的关联。
从 2016 年至 2020 年，共回顾性随访了 17783 例 PLHIV，其中 1466 例（8.2%）存在 LLV，16317 例（91.8%）VL 不可检测。PLHIV 中 LLV 的比例从 2016 年的 2.0%逐渐增加到 2020 年的 8.6%；LLV 与男性、二线 ART 方案和较低年龄相关。1466 例 LLV 患者中有 32.5%（476 例）发生病毒抑制失败，而 16317 例 VL 不可检测的患者中只有 7.7%（1254 例）在随访期间发生病毒抑制失败。与 VL 不可检测的 PLHIV 相比，LLV 的 PLHIV 发生病毒抑制失败的危险率高 4.1 倍（调整后的危险比为 4.1，95%CI：3.7 至 4.7，p < 0.001）。
本研究表明，PLHIV 中 LLV 的比例从 2016 年的 2.0%增加到 2020 年的 8.6%，而与 VL 不可检测的 PLHIV 相比，LLV 的 PLHIV 发生病毒抑制失败的危险率高 4.1 倍。因此，有必要审查乌干达的 VL 检测算法，并对 LLV 进行管理。
