[Incidence and Determinants of Viral Load Rebound in People Receiving Multi-month Dispensing of Antiretroviral Therapy at the Regional Annex Hospital of Dschang from 2018-2023]

Overview

Journal Pan Afr Med J

Date 2025 Feb 24

PMID 39989942

Authors

Elvira Francheska Kengni

Djerry Dunhill Nzapze

Cavin Epie Bekolo

Charles Kouanfack

Affiliations

Soon will be listed here.

Abstract

Introduction: in Cameroon, multi-month dispensing (MMD) of antiretrovirals (ARVs) was introduced to improve treatment adherence among people living with HIV (PLHIV). However, this strategy has limitations that may lead to viral load rebound. The purpose of this study is to assess the incidence and factors associated with viral rebound in PLHIV receiving MMD at the Dschang Regional Annex Hospital between 2018 and 2023.

Methods: we conducted a retrospective cohort study comparing the incidence of viral rebound (increase of over 100 copies/mL after suppression) and its determinants in patients on MMD versus those on monthly dispensing (MD) from January 2018 to December 2023. Data were collected from patients´ medical records using a standardized data collection sheet. Descriptive statistics were followed by bivariate and multivariate analyses to identify factors associated with viral rebound, with a significance threshold of p<0.05.

Results: a total of 519 patients (438 on MMD and 81 on MD) were included. The incidence of viral rebound was 18.8% among patients on MMD compared to 37.8% among those on MD. The male-to-female ratio was 0.53, with the majority of patients aged 30 to 45 years. MMD coverage decreased from 76% in 2018 to 51.02% in 2023. Factors significantly associated with viral rebound included dispensing type (p=0.001), treatment interruption (p=0.001), age group 30-45 years (p=0.001) and tobacco use (p=0.008).

Conclusion: the incidence of viral rebound is higher among patients on MD. Improving the management of PLHIV and promoting healthier lifestyle choices are essential to prevent long-term treatment failure.

References

Neumann A, Tubiana R, Calvez V, Robert C, Li T, Agut H . HIV-1 rebound during interruption of highly active antiretroviral therapy has no deleterious effect on reinitiated treatment. Comet Study Group. AIDS. 1999; 13(6):677-83. DOI: 10.1097/00002030-199904160-00008. View

Bekolo C, Ndeso S, Moifo L, Mangala N, Ateudjieu J, Kouanfack C . Changes in access to viral load testing, incidence rates of viral load suppression and rebound following the introduction of the 'universal test and treat' guidelines in Cameroon: A retrospective follow-up analysis. PLOS Glob Public Health. 2024; 4(4):e0003042. PMC: 11020606. DOI: 10.1371/journal.pgph.0003042. View

Kimera I, Namugenyi C, Schwartz J, Musimbaggo D, Ssenyonjo R, Atukunda P . Integrated multi-month dispensing of antihypertensive and antiretroviral therapy to sustain hypertension and HIV control. J Hum Hypertens. 2022; 37(3):213-219. PMC: 8896410. DOI: 10.1038/s41371-022-00655-3. View

Casalini C, Bateganya M, Akolo C, Sanwo O, Idemudia A, Nwaokoro P . Increasing multimonth dispensing of antiretrovirals and assessing the effect on viral load suppression among children and adolescents receiving HIV services in Nigeria. PLoS One. 2023; 18(6):e0286303. PMC: 10266651. DOI: 10.1371/journal.pone.0286303. View

Mugo C, Zubayr B, Ezeokafor N, Oyawola B, Ekele D, Madueke L . Effect of Dolutegravir and Multimonth Dispensing on Viral Suppression Among Children With HIV. J Acquir Immune Defic Syndr. 2023; 93(3):229-236. PMC: 10256312. DOI: 10.1097/QAI.0000000000003190. View

Boyd A, Jahun I, Dirlikov E, Greby S, Odafe S, Abdulkadir A . Expanding access to HIV services during the COVID-19 pandemic-Nigeria, 2020. AIDS Res Ther. 2021; 18(1):62. PMC: 8449993. DOI: 10.1186/s12981-021-00385-5. View

Bhalerao A, Cucullo L . HIV-1 gp120 and tobacco smoke synergistically disrupt the integrity of the blood-brain barrier. Eur J Cell Biol. 2022; 101(4):151271. PMC: 10120396. DOI: 10.1016/j.ejcb.2022.151271. View

Thorp M, Bellos M, Temelkovska T, Mphande M, Cornell M, Hubbard J . Mobility and ART retention among men in Malawi: a mixed-methods study. J Int AIDS Soc. 2023; 26(3):e26066. PMC: 10029992. DOI: 10.1002/jia2.26066. View

Arnsten J, Demas P, Grant R, Gourevitch M, Farzadegan H, Howard A . Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users. J Gen Intern Med. 2002; 17(5):377-81. PMC: 1495042. View

10.

Ayieko J, Charlebois E, Maeri I, Owino L, Thorp M, Bukusi E . Improving care engagement for mobile people living with HIV in rural western Kenya. PLoS One. 2023; 18(11):e0288087. PMC: 10664942. DOI: 10.1371/journal.pone.0288087. View

11.

Maina E, Mureithi H, Adan A, Muriuki J, Lwembe R, Bukusi E . Incidences and factors associated with viral suppression or rebound among HIV patients on combination antiretroviral therapy from three counties in Kenya. Int J Infect Dis. 2020; 97:151-158. DOI: 10.1016/j.ijid.2020.05.097. View

12.

Opoku S, Sakyi S, Ayisi-Boateng N, Enimil A, Senu E, Ansah R . Factors associated with viral suppression and rebound among adult HIV patients on treatment: a retrospective study in Ghana. AIDS Res Ther. 2022; 19(1):21. PMC: 9131580. DOI: 10.1186/s12981-022-00447-2. View

13.

Geretti A, Smith C, Haberl A, Garcia-Diaz A, Nebbia G, Johnson M . Determinants of virological failure after successful viral load suppression in first-line highly active antiretroviral therapy. Antivir Ther. 2008; 13(7):927-36. View

14.

Shah G, Maluantesa L, Etheredge G, Waterfield K, Ikhile O, Beni R . HIV Viral Suppression among People Living with HIV on Antiretroviral Therapy in Haut-Katanga and Kinshasa Provinces of Democratic Republic of Congo. Healthcare (Basel). 2022; 10(1). PMC: 8775118. DOI: 10.3390/healthcare10010069. View

15.

Chirouze C, Hustache-Mathieu L, Rougeot C, Drobacheff C, Gil H, Faller J . [Risk factors for Abacavir-induced hypersensibility syndrome in the "real world"]. Pathol Biol (Paris). 2004; 52(9):529-33. DOI: 10.1016/j.patbio.2004.07.012. View

16.

Grimsrud A, Wilkinson L . Acceleration of differentiated service delivery for HIV treatment in sub-Saharan Africa during COVID-19. J Int AIDS Soc. 2021; 24(6):e25704. PMC: 8188395. DOI: 10.1002/jia2.25704. View

17.

Msosa T, Swai I, Aarnoutse R, Wit T, Ngowi K, Msefula C . The Effect of Real-Time Medication Monitoring-Based Digital Adherence Tools on Adherence to Antiretroviral Therapy and Viral Suppression in People Living With HIV: A Systematic Literature Review and Meta-Analysis. J Acquir Immune Defic Syndr. 2024; 96(5):411-420. PMC: 11236270. DOI: 10.1097/QAI.0000000000003449. View

18.

Martin L, Williams S, Haskard K, DiMatteo M . The challenge of patient adherence. Ther Clin Risk Manag. 2008; 1(3):189-99. PMC: 1661624. View

19.

Garcia F, Plana M, Vidal C, Cruceta A, OBRIEN W, Pantaleo G . Dynamics of viral load rebound and immunological changes after stopping effective antiretroviral therapy. AIDS. 1999; 13(11):F79-86. DOI: 10.1097/00002030-199907300-00002. View

20.

Mocroft A, Ruiz L, Reiss P, Ledergerber B, Katlama C, Lazzarin A . Virological rebound after suppression on highly active antiretroviral therapy. AIDS. 2003; 17(12):1741-51. DOI: 10.1097/00002030-200308150-00003. View