Determinants of Virologic Failure among HIV-Infected Patients Receiving Antiretroviral Therapy: A Cross-Sectional Study in Indonesia
DOI:
https://doi.org/10.66344/jpad.v36i2.3116Keywords:
virologic failure, body mass index, WHO clinical stage, HIV/AIDSAbstract
Background Individuals with HIV who have compromised nutritional status are at a higher risk of contracting opportunistic infections due to weakened immunity, thereby contributing to increased viral load (VL) levels.
Objective To evaluate the prevalence and determinants of virologic failure in HIV/AIDS patients who had been on antiretroviral (ARV) therapy for at least 12 months.
Methods This study was carried out at an outpatient clinic at Tertiary Referral Hospital and two Public Health Centers from June to August 2023. The study included 74 patients aged 17 years or above who had been receiving ARV treatment for the past 12 months. The determinants evaluated in this research were gender, education, occupation, ARV initiation, ARV type, ARV therapy duration, body mass index, HIV-TB co-infection, and WHO clinical stage.
Results Among the 74 HIV patients included in the study, 35.1% experienced virologic failure. Several factors were found to be significantly associated with virologic failure, including age at antiretroviral (ARV) initiation (P=.007), body mass index (BMI) (P<.001), HIV-TB co-infection (P=0.003), World Health Organization (WHO) clinical stage ( P<.001), and ARV treatment duration (P=.014). Multivariate analysis identified BMI (P=.005) and WHO clinical stage (P=.001) as the strongest predictors of virologic failure.
Conclusion This study concludes that low BMI and WHO clinical stage III/IV are significantly associated with virologic failure. Strengthening the immune system through improving nutritional status is crucial to achieve better virologic suppression in HIV patients receiving ARV therapy.
References
1. Kiweewa F, Esber A, Musingye E, Reed D, Crowell TA, Cham F, et al. HIV virologic failure and its predictors among HIV-infected adults on antiretroviral therapy in the African Cohort Study. PLoS One. 2019;14:e0211344.
doi:10.1371/journal.pone.0211344
2. Gupta-Wright A, Fielding K, van Oosterhout JJ, Alufandika M, Grint DJ, Chimbayo E, et al. Virological failure, HIV-1 drug resistance, and early mortality in adults admitted to hospital in Malawi: an observational cohort study. Lancet HIV. 2020;7:e620–8. doi:10.1016/S2352-3018(20)30172-7
3. World Health Organization. https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/strategic-information/hiv-data-and-statistics. 2025. HIV data and statistics.
4. UNAIDS. https://www.unaids.org/en/resources/presscentre/featurestories/2025/february/20250224_indonesia_fs. 2025. Indonesia: investing in people to avert an HIV crisis.
5. Joya C, Won SH, Schofield C, Lalani T, Maves RC, Kronmann K, et al. Persistent Low-level Viremia While on Antiretroviral Therapy Is an Independent Risk Factor for Virologic Failure. Clinical Infectious Diseases. 2019;69:2145-52. doi:10.1093/cid/ciz129
6. Mesic A, Spina A, Mar HT, Thit P, Decroo T, Lenglet A, et al. Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis. AIDS Res Ther. 2021;18:16. doi:10.1186/s12981-021-00336-0
7. Daltro ACB, Almeida CS, Unfried AGC, de Aquino TR, Travassos AGÁ. Virological failure and adherence to antiretroviral therapy in adolescents and young adults living with human immunodeficiency virus. Trop Med Int Health. 2023 Mar;28(3):162-74. doi: 10.1111/tmi.13854.
8. Masresha SA, Alen GD, Kidie AA, Dessie AA, Dejene TM. First line antiretroviral treatment failure and its association with drug substitution and sex among children in Ethiopia: systematic review and meta-analysis. Sci Rep. 2022;12:18294. doi:10.1038/s41598-022-22237-6
9. Ahmed M, Merga H, Jarso H. Predictors of virological treatment failure among adult HIV patients on first-line antiretroviral therapy in Woldia and Dessie hospitals, Northeast Ethiopia: a case-control study. BMC Infect Dis. 2019;19:305. doi:10.1186/s12879-019-3924-4
10. Abubakari A, Issah H, Mutaka MAO, Asumah MN. Determinants of Virological Failure in HIV Patients on Highly Active Antiretroviral Therapy (HAART): A Retrospective Cross-Sectional Study in the Upper East Region of Ghana. Venereology. 2023;2:16-29. doi:10.3390/venereology2010002
11. Ross J, Jiamsakul A, Kumarasamy N, Azwa I, Merati T, Do C, et al. Virological failure and HIV drug resistance among adults living with HIV on second‐line antiretroviral therapy in the Asia‐Pacific. HIV Med. 2021;22:201-11.
doi:10.1111/hiv.13006
12. Aytenew TM, Asferie WN, Ejigu N, Birhane BM, Tiruneh YM, Kassaw A, et al. Virological failure and associated factors among patients receiving anti-retroviral therapy in Ethiopia: A systematic review and meta-analysis. BMJ Open. 2024;14:e087569. doi:10.1136/bmjopen-2024-087569
13. Fokam J, Sosso SM, Yagai B, Billong SC, Djubgang Mbadie RE, Kamgaing Simo R, et al. Viral suppression in adults, adolescents and children receiving antiretroviral therapy in Cameroon: adolescents at high risk of virological failure in the era of “test and treat.” AIDS Res Ther. 2019;16:36. doi:10.1186/s12981-019-0252-0
14. Van Wyk BE, Davids LAC. Challenges to HIV treatment adherence amongst adolescents in a low socio-economic setting in Cape Town. South Afr J HIV Med. 2019;20:1002. doi:10.4102/sajhivmed.v20i1.1002
15. Fentie Wendie T, Workneh BD. Prevalence and Predictors of Virological Failure Among Adults Living with HIV in South Wollo Zone, Northeast Ethiopia: A Retrospective Cohort Study. HIV AIDS (Auckl). 2020 Sep 7;12:393-402. doi: 10.2147/HIV.S266460.
16. Negash H, Welay M, Legese H, Adhanom G, Mardu F, Tesfay K, et al. Increased Virological Failure and Determinants Among HIV Patients on Highly Active Retroviral Therapy in Adigrat General Hospital, Northern Ethiopia, 2019: Hospital-Based Cross-Sectional Study. Infect Drug Resist. 2020;13:1863-72. doi:10.2147/IDR.S251619
17. Muhie NS. Incidence Rate, Survival Rate, and Predictors for Virological Failure Among Adult TB/HIV Coinfected Clients. J Trop Med. 2025;2025. doi:10.1155/jotm/2011556
18. Getaneh T, Negesse A, Dessie G, Desta M. The impact of tuberculosis co-infection on virological failure among adults living with HIV in Ethiopia: A systematic review and meta-analysis. J Clin Tuberc Other Mycobact Dis. 2022;27:100310. doi:10.1016/j.jctube.2022.100310
19. de Melo Souza J, da Cunha Lopes DN, de Moura Souza W, de Oliveira Lima OC. HIV Co-infection Increases Mortality and Impairs Functional Independence and Physical Performance in Hospitalized Tuberculosis Patients. Open AIDS J. 2025;19:e18746136381141. doi:10.2174/0118746136381141250703062301
20. Fathima AS, Madhu M, Udaya Kumar V, Dhingra S, Kumar N, Singh S, et al. Nutritional Aspects of People Living with HIV (PLHIV) Amidst COVID-19 Pandemic: an Insight. Curr Pharmacol Rep. 2022;8:350-64. doi:10.1007/s40495-022-00301-z
21. Mamo A, Assefa T, Negash W, Tekalegn Y, Sahiledengle B, Teferu Z, et al. Virological and Immunological Antiretroviral Treatment Failure and Predictors Among HIV Positive Adult and Adolescent Clients in Southeast Ethiopia. HIV/AIDS - Research and Palliative Care. 2022;14:73-85. doi:10.2147/HIV.S354716
22. Mekonen H, Negesse A, Dessie G, Desta M, Mihiret GT, Tarik YD, et al. Impact of HIV coinfection on tuberculosis treatment outcomes in Ethiopia: a systematic review and meta-analysis. BMJ Open. 2024;14:e087218. doi:10.1136/bmjopen-2024-087218.
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