Zani Babalwa, Fairall Lara, Petersen Inge, Folb Naomi, Bhana Arvin, Thornicroft Graham, Hanass-Hancock Jill, Selohilwe Oné, Petrus Ruwayda, Carmona Sergio, Lombard Carl, Lund Crick, Levitt Naomi, Bachmann Max
Knowledge Translation Unit, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
King's Global Health Institute, School of Life Course & Population Sciences, Faculty of Life Sciences and Medicine, King's College London, UK.
medRxiv. 2025 Aug 5:2025.08.01.25332690. doi: 10.1101/2025.08.01.25332690.
Unsuppressed viral load during antiretroviral therapy (ART) is associated with health decline and HIV transmission. Being overweight or obese increases the risk of non-communicable diseases, increasing the risk of multimorbidity in people living with HIV. Both ART effectiveness and obesity have been shown to be affected by socioeconomic, psychological and health related factors, but their interrelationships in South Africans living with HIV are not well known.
This was a secondary analysis of data from a randomised controlled trial of depression management in 2002 adults receiving ART. We investigated the effects of sociodemographic characteristics, comorbidities, depression symptoms (Patient Health Questionnaire-9 (PHQ-9)), functional disability (WHODAS-2.0), AIDS-related stigma and ART adherence on viral load non-suppression (viral load ≥1000 copies/ml) and on body mass index (BMI), at baseline (baseline) and on changes 12 months later, using longitudinal mixed effect logistic and linear regression models. Potentially confounding covariates were selected and adjusted for using least absolute shrinkage and selection operator (LASSO) inference.
People with viral load non-suppression at baseline were more likely to be male, younger and to earn lower income. Health characteristics associated with viral load non-suppression at baseline were previous tuberculosis, having been on ART for less than 6 months or more than 10 years, and self-reported non-adherence to ART. Higher disability score and ART duration <6 months or >10 years at baseline were associated with an increasing likelihood of viral load non-suppression 12 months later. Higher BMI at baseline was associated with being female, being married, earning higher income and hypertension, no history of tuberculosis and not having viral load non-suppression. BMI increased from baseline to follow-up, and younger age was associated with a greater increase in BMI 12 months later. Depression symptom scores and stigma scores were not associated with viral load non-suppression or BMI.
Viral load non-suppression was associated with lower BMI, most likely due to its effects on HIV-related illness. Viral load non-suppression and BMI were both associated with a variety of sociodemographic factors, while viral load non-suppression was also associated with disability and ART non-adherence. These findings together indicate subgroups of people with HIV who most need improved ART access and adherence support. Neither outcome was associated with severity of depression symptoms or self-reported stigma.ClinicalTrials.gov (NCT02407691), Pan African Clinical Trials Registry (201504001078347), South African National Clinical Trials Register (SANCTR) (DOH-27-0515-5048, NHREC 4048).
抗逆转录病毒疗法（ART）期间病毒载量未得到抑制与健康状况下降及HIV传播相关。超重或肥胖会增加非传染性疾病的风险，进而增加HIV感染者患多种疾病的风险。已有研究表明，ART疗效和肥胖均受社会经济、心理及健康相关因素的影响，但在南非HIV感染者中，它们之间的相互关系尚不清楚。
这是一项对2002名接受ART的成年人进行的抑郁症管理随机对照试验数据的二次分析。我们使用纵向混合效应逻辑回归和线性回归模型，调查了社会人口学特征、合并症、抑郁症状（患者健康问卷-9（PHQ-9））、功能残疾（世界卫生组织残疾评定量表2.0（WHODAS-2.0））、艾滋病相关耻辱感和ART依从性在基线时以及12个月后的变化对病毒载量未抑制（病毒载量≥1000拷贝/毫升）和体重指数（BMI）的影响。使用最小绝对收缩和选择算子（LASSO）推断法选择并调整潜在的混杂协变量。
基线时病毒载量未得到抑制的人更可能为男性、较年轻且收入较低。与基线时病毒载量未得到抑制相关的健康特征包括既往有结核病、接受ART治疗少于6个月或超过10年以及自我报告的ART治疗不依从。基线时残疾评分较高以及ART治疗时间<6个月或>10年与12个月后病毒载量未得到抑制的可能性增加相关。基线时较高的BMI与女性、已婚、收入较高、患有高血压、无结核病病史以及病毒载量未得到抑制无关。BMI从基线到随访有所增加，且较年轻与12个月后BMI的更大增加相关。抑郁症状评分和耻辱感评分与病毒载量未抑制或BMI无关。
病毒载量未得到抑制与较低的BMI相关，最有可能是因为其对HIV相关疾病的影响。病毒载量未得到抑制和BMI均与多种社会人口学因素相关，而病毒载量未得到抑制还与残疾和ART治疗不依从相关。这些发现共同表明了最需要改善ART治疗可及性和依从性支持的HIV感染者亚组。两种结果均与抑郁症状的严重程度或自我报告的耻辱感无关。ClinicalTrials.gov（NCT02407691）、泛非临床试验注册中心（201504001078347）、南非国家临床试验注册中心（SANCTR）（DOH-27-0515-5048，NHREC 4048）。
