Boateng Anthony T, Aboagye James O, Lamptey Helena, Abana Christopher Z-Y, Abaidoo-Myles Araba, Quansah Darius N K, Agyemang Seth, Awuku-Larbi Yaw, Ansa Gloria, Oliver-Commey Joseph, Ganu Vincent, Kyei George B, Puplampu Peter, Bonney Evelyn Y
Department of Virology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana.
West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana.
Front Public Health. 2025 Mar 19;13:1508793. doi: 10.3389/fpubh.2025.1508793. eCollection 2025.
Regular viral load (VL) testing for people living with HIV (PLWH) is key to attaining the Joint United Nations Program on HIV/AIDS (UNAIDS) Fast-Track 95-95-95 target to end the HIV epidemic by 2030. However, VL testing remains sporadic in routine HIV care in the majority of resource-limited settings, including Ghana, except when provided through research initiatives. In this study, we measured VL among PLWH in Ghana at regular intervals and investigated factors affecting viral suppression (VS) and rebound.
We analyzed data from a hospital-based cohort enrolled in our HIV cure research. Participants were recruited from three hospitals in the Greater Accra region of Ghana. Demographic characteristics were obtained from participants' folders, while CD4 T cell counts and VLs were measured from blood samples collected at baseline, 6 months, and 18 months.
The study participants were predominantly women (68%) with a median age of 45 years (IQR: 21-76 years). A total of 52% of participants had been on antiretroviral therapy (ART) for more than 6 years, and 74% were following dolutegravir-based regimens. At baseline, 74% of participants had a VL of <50 copies/mL, which increased to 88% at 18 months, with 80% having a CD4 T cell count of >350 cells/μl. Age group [<40 vs. > 40 years] (OR 2.35, 95% CI; 1.21-4.58, = 0.012), CD4 T cell count [>350 vs. < 350 cells/μl] (OR 4.35, 95% CI; 2.32-8.18, < 0.001), and ART regimen [NVP based vs. DTG based] (OR 7.00, 95% CI; 1.15-42.57, = 0.034) were associated with VS of <50 copies/mL. The overall viral rebound rate was estimated at 13.61 per 1,000 person-months (95% CI 10.52-17.74), with decreasing rates over time. Lower educational levels (up to Junior High School) were significantly associated with viral rebound ( = 0.011).
A key feature of our study was measuring VL at three time points over 2 years, which may explain the high VS levels observed. Viral rebound was linked to low education levels, highlighting the need for targeted education for PLWH with junior high school (JHS) education or less. Regular VL monitoring and the implementation of measures to prevent viral rebound, particularly among PLWH with lower education levels, will help Ghana move closer to attaining the third "95" of the UNAIDS 95-95-95 target by 2030.
对艾滋病病毒感染者（PLWH）进行定期病毒载量（VL）检测是实现联合国艾滋病规划署（UNAIDS）到2030年终结艾滋病流行的“95-95-95”快速通道目标的关键。然而，在包括加纳在内的大多数资源有限的环境中，除了通过研究项目提供检测外，VL检测在常规艾滋病护理中仍然是零星的。在本研究中，我们定期测量了加纳PLWH的VL，并调查了影响病毒抑制（VS）和病毒反弹的因素。
我们分析了参与我们艾滋病治愈研究的一个医院队列的数据。参与者从加纳大阿克拉地区的三家医院招募。人口统计学特征从参与者的病历中获取，而CD4 T细胞计数和VL则从基线、6个月和18个月采集的血样中测量。
研究参与者以女性为主（68%），中位年龄为45岁（四分位间距：21-76岁）。共有52%的参与者接受抗逆转录病毒治疗（ART）超过6年，74%的参与者采用基于多替拉韦的治疗方案。基线时，74%的参与者VL<50拷贝/毫升，18个月时增至88%，80%的参与者CD4 T细胞计数>350个细胞/微升。年龄组[<40岁与>40岁]（比值比2.35，95%置信区间；1.21-4.58，P = 0.012）、CD4 T细胞计数[>350个细胞/微升与<350个细胞/微升]（比值比4.35，95%置信区间；2.32-8.18，P < 0.001）以及ART治疗方案[基于奈韦拉平与基于多替拉韦]（比值比7.00，95%置信区间；1.15-42.57，P = 0.034）与VL<50拷贝/毫升的VS相关。总体病毒反弹率估计为每1000人月13.61（95%置信区间10.52-17.74），且随时间下降。较低的教育水平（初中及以下）与病毒反弹显著相关（P = 0.011）。
我们研究的一个关键特征是在2年的三个时间点测量VL，这可能解释了观察到的高VS水平。病毒反弹与低教育水平有关，突出了对初中及以下教育水平的PLWH进行针对性教育的必要性。定期VL监测以及实施预防病毒反弹的措施，特别是在教育水平较低的PLWH中，将有助于加纳更接近实现UNAIDS“95-95-95”目标的第三个“95”，即到2030年实现95%的病毒抑制。
