Reasons for failure to suppress viral load in patients undergoing antiretroviral therapy

Background: Suppressing viral load (VL) is a primary goal of antiretroviral therapy (ART), both for the health of individuals living with HIV and to reduce transmission. However, in the Democratic Republic of Congo (DRC), a significant number of patients do not reach this threshold, which compromises the health gains that have been made. This study aims to explore the factors underlying this failure at the HIV/AIDS Center of Excellence at the University of Lubumbashi. Methods: A rétrospective cross-sectional study was conducted among 144 patients who had been on ART for six months. The data collected included sociodemographic, clinical (viral load, co-infections), behavioral (adherence), and structural (access to care) variables. Statistical analyses, including logistic regression, were used to identify factors associated with non-suppressed viral load (≥1000 copies/ml). Results: The prevalence of non-suppression was 34%. The most significant factors were poor adherence (OR = 3.2), living in a rural area (OR = 2.0), and co-infection with tuberculosis (OR = 1.8). Conclusion: The causes of viral non-suppression are multiple and interdependent. They involve treatment adherence, geographical inequalities, and the management of co-infections. Integrated approaches adapted to the Congolese context are imperative if the UNAIDS 95-95-95 targets are to be achieved.