Hlophe Londiwe D, Shumba Constance S, Bedada Diribsa T, Nyasulu Peter S
Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, United States of America.
BMC Infect Dis. 2025 Apr 10;25(1):493. doi: 10.1186/s12879-025-10872-z.
The goal of antiretroviral therapy (ART) is to achieve a sustained HIV suppressed viral load. However, adolescents often present poor adherence to ART which is associated with lower rates of viral load suppression (VLS). The objective of this study was to determine the viral load suppression levels and the associated factors among adolescents living with HIV (ALHIV) and on ART in Eswatini.
We conducted cross-sectional analysis of data from 911 adolescents aged 10 to 19 living with HIV and on ART between the period January 2017 and September 2022. We collected data of demographic and clinical variables, using a standardized data abstraction tool. We defined viral load suppression as the latest viral load result of ≤ 1000 copies/ml. Univariable and bivariable logistic regression analysis was done to identify factors associated with VLS and factors with p < 0.1 were included in the multivariable regression analysis to adjust for the confounding effect of other variables such as age, sex, and duration of ART. Factors with p < 0.05 were considered statistically significant.
Among the 911 participants, 60% (457) were female. The mean age of the participants was 16.3 years, with mean duration on ART of 1.8 years. Viral suppression was attained by 88.5% (806/911) of the participants. Residence in the Shiselweni region was an independent factor associated with viral load suppression (aOR 0.37; 95% CI 0.15-0.19; p˂0.027).
Low VLS is a risk factor for increased viral resistance and perpetuates HIV transmission within the population. Achieving viral suppression among ALHIV in Eswatini is challenging as data shows that VLS is way below the UNAIDS 95% cut off level among individuals on ART. This is particularly more problematic in the Shiselweni region, where viral suppression is lower than the other regions. Therefore, reinforcement of public health interventions is needed to improve treatment support for achieving sustained viral suppression among ALHIV in Eswatini.
抗逆转录病毒疗法（ART）的目标是实现持续的HIV病毒载量抑制。然而，青少年对抗逆转录病毒疗法的依从性往往较差，这与较低的病毒载量抑制率（VLS）相关。本研究的目的是确定斯威士兰接受抗逆转录病毒治疗的感染HIV青少年（ALHIV）的病毒载量抑制水平及其相关因素。
我们对2017年1月至2022年9月期间911名年龄在10至19岁之间接受抗逆转录病毒治疗的感染HIV青少年的数据进行了横断面分析。我们使用标准化的数据提取工具收集了人口统计学和临床变量数据。我们将病毒载量抑制定义为最新病毒载量结果≤1000拷贝/毫升。进行单变量和双变量逻辑回归分析以确定与病毒载量抑制相关的因素，p<0.1的因素纳入多变量回归分析以调整年龄、性别和抗逆转录病毒治疗持续时间等其他变量的混杂效应。p<0.05的因素被认为具有统计学意义。
在911名参与者中，60%（457名）为女性。参与者的平均年龄为16.3岁，抗逆转录病毒治疗的平均持续时间为1.8年。88.5%（806/911）的参与者实现了病毒抑制。居住在希塞尔韦尼地区是与病毒载量抑制相关的独立因素（调整后的比值比0.37；95%置信区间0.15-0.19；p<0.027）。
低病毒载量抑制是病毒耐药性增加的危险因素，并使HIV在人群中持续传播。在斯威士兰实现感染HIV青少年的病毒抑制具有挑战性，因为数据显示，在接受抗逆转录病毒治疗的个体中，病毒载量抑制远低于联合国艾滋病规划署设定的95%的临界水平。这在希塞尔韦尼地区尤为突出，该地区的病毒抑制率低于其他地区。因此，需要加强公共卫生干预措施，以改善治疗支持，从而在斯威士兰实现感染HIV青少年的持续病毒抑制。
