Risk factors affecting the epidemic effectiveness of antiretroviral therapy for HIV-infected patients in the Vologda region

The aim of this study was to investigate risk factors that influence the epidemic effectiveness of antiretroviral therapy.

Materials and methods. Data on incidence, prevalence, mortality, the number of new HIV infections, the number of deaths from HIV-infected individuals, the number of people living with HIV (PLHIV), the number of patients receiving antiretroviral therapy (ART), and viral load (VL) and immune status (IS) testing results were analyzed.

Results and discussion. Antiretroviral therapy has been used in the Vologda Oblast for 19 years and, in 2023, covers 82.1% of the total number of people living with HIV and 86.1% of patients registered for dispensary care. Based on an analysis conducted in the region between 2005 and 2023, the number of people living with HIV increased by 4.1 times, while the number of patients registered for follow-up care increased by 5.5 times. All patients were eligible for treatment monitoring, and 94.8% were tested for viral load. During this period, a positive impact of antiretroviral therapy on the HIV epidemic has been observed, as evidenced by a decrease in the number of new cases and the number of patients not registered for follow-up care. It is also worth noting the increase in the proportion of patients in the clinical manifestation stage, which increased from 25% to 50%. The effectiveness of ART is negatively impacted by factors including incomplete ART coverage among PLHIV under clinical observation (86.1%), a long period of therapy initiation from diagnosis (averaging 358 days), non-adherence to therapy among PLHIV (33.1%), and the achievement of an undetectable viral load in only 80.8% of PLHIV.

Conclusion. An analysis of the development of HIV infection in the Vologda Oblast demonstrates a positive impact of the widespread use of antiretroviral therapy on the incidence rate, with stabilization noted. Currently, the epidemic can be classified as developing severe and comorbid forms of HIV. No reduction in HIV-related mortality has been observed with the use of antiretroviral therapy. Even with full treatment coverage, comprehensive organizational and preventive programs are necessary to impact the epidemic.

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