Abstract
Introduction
The WHO reports the ongoing transmission of HIV, which affects millions worldwide, with the African region accounting for two-thirds of the total number of new infections. In Cambodia, approximately 76,000 people are living with HIV (PLHIV), 99.0% of whom are aware of their HIV status and receiving treatment, and 98% have a reduced viral load. This study aimed to describe the epidemiological and clinical characteristics of PLHIV, including the general population (GP), female entertainment worker (FEW), men who have sex with men (MSM), transgender (TG), people who inject drugs (PWID), and people who use drugs (PWUD), and to determine whether viral load suppression is associated with the treatment regimen in this population.
Methods
A cross-sectional analysis of antiretroviral treatment (ART) data from 2022 was conducted using 22,768 records from the National Center for HIV/AIDS, Dermatology and STIs (NCHADS) database of PLHIV receiving ART at Phnom Penh. The data were analyzed with STATA (version 15.1 SE). Descriptive statistics and cross-tabulations of the variables of interest were analyzed.
Results
Approximately 56.0% of the PLHIV were men. The mean age was close to 43.0 years (median = 44.0). Close to 15% of PLHIV were aged 40--44 years, and 76.8% of participants residing in Phnom Penh. GP accounted for more than 90% of the treated PLHIV, followed by MSM/transgender and other risk groups. A total of 76.1% of them had CD4 levels ≥ 350 cells/mm3. Among 21,021 PLHIV, the viral load was <1,000 copies/ml, and 97.5% were on ART>5 years. Close to 60% of PLHIV were treated with the TLD regimen [tenofovir (TDF), lamivudine and dolutegravir (DTG)], 24.9% were treated with TLE regimens [TDF, lamivudine, and efavirenz (EFV)], and 15.2% were treated with other regimens. A suppressed viral load of less than 1000 copies was significantly different among PLHIV treated with the TLD/DTG-based regimen (89.6%), TLE regimen (97.3%), and other ART regimens (94.9%), with a p value <0.001.
Conclusion
This study revealed that TLD is recognized and widely used as a first-line treatment regimen since it is effective in PLHIV care management and treatment. Many studies have suggested that rapid suppression of the viral load with the TLD regimen can significantly improve patients' health and lives. This study, however, revealed that TLE treatment regimen had greater viral load suppression. This discrepancy could be attributed to the study design, setting, and technical analysis. Therefore, further analyses should explore the effects of TLD on viral load suppression compared with those of TLE across patient characteristics, such as duration of ART, age groups, adherence status, and comorbidities.