Time to viral suppression and its predictors among treatment-experienced people living with HIV switched to third-line antiretroviral therapy at a specialized center in Uganda
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Background: As of 2023, Uganda had approximately 1.44 million people living with HIV (PLHIV) on antiretroviral therapy (ART). While the majority are on first- and second-line ART, an increasing number of PLHIV are being switched to third-line ART due to treatment failure. However, there is limited evidence on the time to viral load (VL) suppression and its predictors among PLHIV initiated on third-line ART in Uganda. This study, therefore, aimed to determine the time to VL suppression and its predictors among PLHIV switched to 3 rd line ART at a specialized centre in Uganda. Methods: This was a retrospective cohort study carried out at the Joint Clinical Research Centre (JCRC) in Lubowa, Uganda, among PLHIV initiated on third-line ART after documented second-line ART failure, between 1 st January 2013 to 1 st August 2024. All 291 eligible participants were included in the study. Time to VL suppression was determined using the Kaplan-Meier survivor function. Predictors of time to VL suppression were determined using an interval-censored Weibull parametric model, with results expressed as adjusted hazard ratios (AHR) and 95% confidence intervals (CI). Results: The median time to VL suppression was 7 months (95% CI: 6-8). The predictors of time to VL suppression were: a baseline CD4 count > 200 cells/mm 3 compared to ≤ 200 cell/mm 3 (AHR: 1.45; 95% CI: 1.04-2.03, P=0.027), baseline VL > 100,000 copies/mL compared to ≤ 100,000 copies/mL (AHR:0.57 95% CI: 0.41-0.78, P < 0.001), and being initiated on tenofovir disoproxil fumarate/lamivudine/darunavir-ritonavir/raltegravir (TDF/3TC/DRV-r/RAL) regimen versus etravirine/darunavir-ritonavir/raltegravir (ETR/DRV-r/RAL) regimen (AHR, 0.65; 95% CI: 0.43-0.98). Conclusion: The median time to VL suppression observed in the study exceeded the WHO and CDC recommendations. Higher CD4 count, lower baseline VL, and ETR/DRV-r/RAL regimen were associated with faster viral suppression. These findings highlight the importance of timely switching, more frequent VL monitoring, and regimen optimization to improve treatment outcomes.
