Although testing for viral load has become the preferred monitoring method for PLHIV and allows for the identification of treatment failure, virological assessment is still the gold standard for following patients on antiretroviral therapy. HIV transmission decline is correlated with virological suppression [15–17]. A study found that individuals who received combination therapy for at least 24 weeks experienced a virological recovery rate of 6986 (90.9%), including long-term suppression and very low viral replication levels even 48 weeks later, comparable to research in Sub-Saharan Africa countries like Malawi [18] and South Africa [19]. The study's findings were significantly higher than those from other regions, including Europe [20], the West (81.5%), East (87.3%), South (86.6%), and central Africa (85.3%) from SSA [21]. The study's results are likely lower than those from Uganda [22] and Vietnam [23], and fall short of the global 95% [24]. Variations in viral load analysis sites, PCR methods, research designs, patient age, socioeconomic factors, reporting thresholds, ART guidelines, adherence levels, drug accessibility, therapeutic regimens, and patient clinical and genetic presentations may cause differences.
Female partners are more likely to achieve long-term virological recovery in HIV-positive individuals using HAART (4.24; 95% CI (2.97–6.03)). Research from South Africa and the Democratic Republic of the Congo indicates that female partners are more likely to achieve long-term virological recovery in HIV-positive individuals [25, 26]. However, research from Ethiopia and South Africa contradicts our findings [27, 28]. The survey results show a gender disparity, with Ethiopia and South Africa having a higher proportion of men compared to the current survey, which has a slightly higher female majority.
Participants aged 16–30 at ART enrollment were twice as likely to have persistent viral load recovery as younger participants, while individuals aged 3–18 and adults aged 19–35 and 36–52 showed significantly better virological recoveries than reference categories over 53 years old. Age inflation enhances virologic response, as supported by other studies [29–31] and Latin American cohort data [32]. However, some studies found no difference in age variations, possibly due to differences in study designs, sample size, ART adherence, medication, and clinical settings [33–35].
The WHO clinical stages significantly impact viral suppression, with patients with WHO Stages I and II at enrollment and in recent ART engagements having lower expected odds of having a detected viral load compared to HIV patients with advanced AIDS disease. HIV patients with WHO stages III and IV exhibit higher viremea and aggravated immune suppression compared to those with stages I and II, a fact that is scientifically justified [33, 36]. Individuals in Stage III and IV were found to be in a severe state, with a high likelihood of developing a detectable viral load [33, 36, 37].
The baseline CD4 cell count significantly influences HIV patients' detectable viral load, with a higher count indicating a lower likelihood of detectable viral load, potentially promoting virological recovery even after extended therapy [38–40]. Low CD4 counts at treatment initiation can cause late HIV diagnosis, advanced AIDS, severe immunosuppression, and increased risk of opportunistic infections, leading to unmonitored viral replications [41, 42].
The study reveals that medication adherence significantly impacts viral load status, suggesting that fair adherent individuals may have lower viral load than good adherent patients [43–45]. The study suggests that patients who adhere to their prescribed medication may have lower virus replication and a longer life span, possibly due to effective counseling or proximity to adherence.
Patients on antiretroviral therapy (ART) for six months, three years, or seven years had a higher chance of virological recovery compared to those on ART for more than ten years; this finding was consistent with a study carried out in Nigeria [46]. Extended therapy is generally expected to lead to virological recovery in patients, but this may be questioned if regular patients are unable to adhere to their prescribed medications.
Teens who start antiretroviral therapy later in life have a lower risk of viral suppression, suggesting that users who are more "settled" in their care and control their viral expression are associated with long-term low viral replication, suggesting younger children may be more comfortable with their daily routine [40].
Virological recovery requires appropriate ART. In the current study, participants who were on the treatments of 1d (AZT + 3TC + EFV) and 1e (TDF + 3TC + EFV) at therapy initiation and on most recent therapy engagement were obtained to show low viral replication that implies for persistent virological recovery compared to lamuvidine (d4T) and Nevirapine (NVP) based therapy users as obtained from clinical trial based studies [47–49]. Previous studies from Ethiopia, Uganda, and Vetnam have shown that children on efavrinaze-based therapies have better outcomes for persistent virological suppression [38, 50, 51]. Variations in drug efficacy may be attributed to factors such as mitochondrial and hepatic toxicity, genetic variations, and drug suitability [52–54].This study found that a suppressed viral load level after 24 weeks of therapy was linked to three times more persistently low viral replication even after 48 weeks and more being on treatment compared with high viral load level at base line which makes it difficult for persistent suppression even after more time being on therapy as reported from studies[41, 55].
Limitations of the Study
The study utilized a holistic approach to evaluate viral load, avoiding aggregates due to fragmented data and high data incompleteness. The retrospective design prevented causality, as behavioral, genetic, and residential characteristics influencing virological recovery were not considered. However, the frailty model was used to determine observed variables' effects after controlling for unmeasured ones.