Levels and Predictors of Unsuppressed Viremia among People Living with HIV on ART in an Urban Population of North-Central Nigeria: A Retrospective Cross-sectional Study

Abstract

Achieving viral suppression is crucial for the effective management of HIV. We investigated the prevalence and predictors of unsuppressed viremia among adults living with HIV (PLHIV) on antiretroviral therapy (ART) in the urban city of Jos, Plateau State, North-central Nigeria. A cross-sectional study was conducted with 2,748 PLHIV, comprising 1,902 females (69.2%) and 846 males (30.8%). The majority (71.0%) were aged 36-55 years. Most participants (88.1%) were on the first-line ART regimen tenofovir disoproxil fumarate-lamivudine-dolutegravir (TDF+3TC+DTG), with 6.0% on second-line regimens. The prevalence of unsuppressed viremia (viral load >1,000 copies/mL) was assessed, and predictors were identified using chi-square tests and logistic regression analyses. Overall prevalence of unsuppressed viremia was 4.0% (110 participants), with higher proportions among males (5.6%) compared to females (3.3%) and among those aged 18-35 years (7.9%) compared to other age groups. PLHIV on first-line TDF+3TC+DTG ART had the lowest level of unsuppressed viremia (2.6%). Chi-square tests revealed significant associations between unsuppressed viremia and gender (χ2=7.67, p=0.01), age group (χ2=13.19, p=0.01), and ART regimen (χ2=110.97, p=0.0001). Multivariate logistic regression identified males (AOR=1.69; 95% CI: 1.12-2.56), younger age groups (18-35 years: AOR=12.96; 95% CI: 2.12-79.09 and 36-45 years: AOR=12.84; 95% CI: 3.70-44.64), and non-TDF+3TC+DTG regimens as significant predictors of unsuppressed viremia. The study highlights the effectiveness of the TDF+3TC+DTG regimen and the need for targeted interventions to address disparities in viral suppression, particularly among males and younger individuals. These findings are crucial for optimizing HIV treatment strategies and improving health outcomes for PLHIV in urban areas of low-and-middle-income countries.