Hubei cohort identifies factors linked to HIV non-suppression at 24 weeks

A retrospective cohort study of 4,535 treatment-naive people with HIV in Hubei, China, found that 6.81% had HIV RNA above 200 copies/mL 24 weeks after starting antiretroviral therapy. Higher baseline viral load and infection attributed to illicit drug use were associated with greater odds of non-suppression; INSTI-based initial regimens and higher CD4 counts were associated with lower odds.

6.81% had HIV RNA above 200 copies/mL at week 24.
Higher baseline viral load was associated with non-suppression.
INSTI-based regimens were associated with lower odds.
Retrospective regional data cannot establish causal effects.

Researchers analyzed records from the Hubei Provincial Center for Disease Control and Prevention HIV database for treatment-naive people who started antiretroviral therapy between February 2022 and June 2025. The primary outcome was virological non-suppression at week 24, defined as plasma HIV RNA above 200 copies/mL. Logistic regression was used to assess associations with baseline demographic, clinical and treatment factors.

Among 4,535 participants, 6.81% had non-suppression at 24 weeks. In adjusted analyses, INSTI-based initial regimens were associated with lower odds than other regimens (adjusted odds ratio [aOR] 0.35, 95% CI 0.26–0.48). Higher baseline CD4 counts were also associated with lower odds, while higher baseline viral load was associated with higher odds (aOR 1.83, 95% CI 1.57–2.13). Infection attributed to illicit drug use had the strongest reported association (aOR 9.88, 95% CI 2.90–33.60). Female sex was associated with lower odds (aOR 0.65, 95% CI 0.46–0.93).

The findings may help identify patients for closer early monitoring and adherence support, as the authors suggest. This retrospective regional study reports associations, not causal effects; its findings do not by themselves establish that changing regimens will improve outcomes, and applicability beyond Hubei is uncertain.

In practice

For treatment-naive people with HIV starting ART, this Hubei cohort found that higher baseline viral load, lower CD4 count and infection attributed to illicit drug use were associated with greater odds of HIV RNA remaining above 200 copies/mL at 24 weeks; INSTI-based initial regimens were associated with lower odds. These findings may inform early monitoring and adherence-support prioritization, as proposed by the authors. Because the study was retrospective and observational, it cannot establish causality or show that changing a regimen improves suppression; applicability outside this regional cohort is also uncertain.

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Source

BMC Public Health: Prevalence and determinants of virological non-suppression at 24 weeks among people living with HIV in Hubei, China ↗

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