Pro-inflammation and clinical correlates of unsuppressed HIV-viral load in children living with perinatally-acquired HIV 1 in Zambia

Abstract

Background Children living with perinatally-acquired HIV-1 (CPHIV) face significant health challenges despite advancements in antiretroviral therapy (ART). This study aimed to determine the association between unsuppressed HIV RNA viral load (VL), proinflammatory markers, sociodemographic, and clinical factors among CPHIV attending routine ART clinic at Arthur Davison Children’s Hospital (ADH), Ndola, Zambia. Methods We conducted a cross-sectional study on 135 CPHIV, aged 2−18 years, who had been on ART for over 12 months. Sociodemographic, clinical, and laboratory data were collected using a standardized questionnaire and a data collection form. The primary outcome was unsuppressed HIV RNA VL defined as a viral load greater than 1000 copies/mL of HIV-1 RNA after at least 6 months of ART treatment. Bivariate and multivariate logistic analyses were conducted to assess associations with unsuppressed HIV viral load. Results Overall median (Q1 - Q3) age was 15 years (12–17) and 59.3% were male. The proportion of CPHIV with unsuppressed HIV VL was 15.6% (n = 21, 95% confidence interval (CI): 9.9–22.8%). Factors associated with unsuppressed VL in multivariate logistic regression were poor adherence to ART (missing two or more doses in 2 weeks) (adjusted OR (AOR) = 14.96; 95% CI: 2.39–93.49, p = 0.004) and lower CD4 count (AOR; 0.99, 0.99–1.00, p = 0.026). Proinflammatory markers tumor necrosis factor-alpha (TNF-α) (p = 0.196) and D-dimer (p = 0.709) did not differ between the suppressed and unsuppressed CPHIV. Conclusion One in six children with perinatally acquired HIV in Ndola, Zambia, had unsuppressed viral load, which was associated with poor ART adherence and lower CD4 counts. Proinflammatory markers, TNF-α and D-dimer, showed no significant differences between suppressed and unsuppressed groups, suggesting they may not be reliable indicators of viral control. Enhanced adherence support and further research on immune dysregulation are needed.