Epidemiological characteristics of people living with HIV on antiretroviral therapy (ART) in Pointe-Noire, Republic of Congo

Epidemiological characteristics of people living with HIV on antiretroviral therapy (ART) in Pointe-Noire, Republic of Congo | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Epidemiological characteristics of people living with HIV on antiretroviral therapy (ART) in Pointe-Noire, Republic of Congo Arcy Marcelin Elenga Ike, Claujens Chastel Mfoutou Mapanguy, Jeannhey Christevy Vouvoungui, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7622263/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Jan, 2026 Read the published version in BMC Infectious Diseases → Version 1 posted 11 You are reading this latest preprint version Abstract Introduction HIV infection continues to be a major contributor to morbidity and mortality in develpping countries, including the Republic of the Congo. The progression of the infection to advanced stages is influenced by various factors such as viral genetics, host immune responses variation, body mass index (BMI), treatment interruption or lack of treatment access. This study describes the characteristics of HIV patients on ART and identifies factors associated with viral load suppression in a Congolese urban population. Methods This cross-sectional study was conducted from June to July 2021 in Pointe Noire. Patients were recruited at the ‘Centre Avenir Positif’. Following a clinical evaluation by a healthcare provider, socio-behavioral, sociodemographic, and clinical data were extracted from patients updated medical records, in addition 5 mL of individual blood was sampled for viral load measurement, using Xpert®-HIV-1 Viral Load assay. Results A total of 510 known HIV positive patients were included in this study. Most of them were women 311 (61%). The analysis revealed a positive association (p = 0.022) between age groups and HIV disease stage, with stage II more prevalent in younger patients (1–17 years) and stage III more common in adults (18–50 years). Tuberculosis (15.6% at Stage I, 36.44% at Stage II, and 51.7% at Stage III) (p < 0.001) and candidiasis (p = 0.023) were two opportunistic infections significantly associated with the advanced stages of the disease. In addition, a significantly association was found between treatment interruption (11.6%) and the advanced phase of the disease (Stage III, p < 0.01). Body mass index was statistically significantly associated with advanced stage of the disease: the proportion of cases with elevated BMI was high in Stage III (58.6%; p = 0.041). Finally, patients who delayed initiating antiretroviral treatment more than five years after being tested HIV positive were 2.33 times more likely to have an unsuppressed viral load ( p = 0.073). Conclusion Factors such as tuberculosis, candidiasis, treatment interruption, underweight and delaying antiretroviral treatment initiation were significantly associated with the disease severity. Regular monitoring of these factors is essential for tracking HIV/AIDS status and improving patient management and clinical counseling. HIV/AIDS associated factors clinical stages Pointe-Noire Republic of Congo Figures Figure 1 1. Introduction Human immunodeficiency virus (HIV) infection and subsequent progression to AIDS with the development of opportunistic infections remains a serious public health problem worldwide [ 1 ]. UNAIDS reported in 2024 that there were approximately 39.9 million people living with HIV around the world [ 2 ]. For decades, infection with HIV was considered as an invariably fatal, life span-limiting disease. Now the infection is manageable with an appropriate antiretroviral therapy (ART), facilitating long-term if not life-long prevention of disease progression; though there is still no cure. The severity of HIV infection varies according to several factors including human-host, viral, and environmental factors. The World Health Organization (WHO) issued recommendations for the management of HIV/AIDS [ 3 ], and categorized the disease into three levels or stages (from stages 1 to 3). In that nomenclature, stage 1 corresponds to the asymptomatic phase; stage 2 corresponds to the acute phase of the disease; and stage 3 corresponds to the AIDS phase of the disease [ 4 ]. Treatment failure has also been shown to influence the progression of an HIV infection to AIDS. In addition, factors such as viral genetics, host immune responses, environmental co-factors, the mechanism of ART drugs action, patients' difficulties in adhering to medical prescriptions, and healthcare system weaknesses were also found to be associated with HIV progression to AIDS. For instance, a study conducted in China among HIV-infected patient on ART reported a significant association between higher baseline CD4 T-cell counts and adherence to ART and non-progression of HIV to AIDS, whilst older age at diagnosis (up to 36 years) and marital status were associated with increased probability to advance to AIDS [ 5 ]. Understanding these factors is essential for developing personalized treatment plans and implementing adapted public health strategies for efficient HIV epidemic management tailored to local circumstances. In 2023; of approximately 120,000 people living with HIV in the Republic of Congo, only 38,000 (31.6%) were on ART [ 6 , 7 ]. According to a recent UNAIDS report (2024), the prevalence of HIV in the adult Congolese population was approximately 3.4%, with more women than men being (sex ratio 2.4) infected, and only 35% of people living with HIV knowing their status [ 7 , 8 ]. Currently, the country is still far from achieving at least one of the three WHO 95-95-95 goals [ 9 ]. There is limited data on the characteristics of HIV patients receiving ART in the Republic of Congo, particularly regarding the proportion achieving viral suppression, which is a key indicator for monitoring treatment effectiveness and epidemic control. In addition, few studies have systematically examined the socio-demographic, clinical, and treatment-related factors associated with viral suppression in this context. The present epidemiological study describes the characteristics of HIV patients under ART and identifies factors associated with viral load suppression in this Congolese population. 2. Materials and Methods 2.1. Study type and period This was a cross-sectional study conducted in HIV patient population with one point contact in time according to their previous WHO stage. The study was conducted from June to July 2021 in Pointe-Noire, Republic of Congo. 2.2. Site and study population The study was conducted at the centre of the ‘Association Avenir Positif’ (AAP) in Pointe Noire, with support from the ‘Centre de recherche sur les maladies infectieuses Chistophe-Mérieux’ (CeRMI-CM) in Brazzaville, thus located in the economic and political capital cities, of the Republic of Congo, respectively. The AAP is a non-profit association set up in 2007 in Pointe-Noire by parents of HIV positive children, with the aim of improving the children quality of life including adolescents and young people. This centre was used for patient enrolment, data and sample collection. The City of Pointe-Noire is divided into six districts, with a population of over 1.1 million inhabitants out of the 6.1 million countrywide [10]. The ‘Centre de recherche sur les maladies infectieuses Chistophe-Mérieux (CeRMI-CM)’ was created in Brazzaville by the Congolese Foundation for Medical Research (FCRM) in 2018. It conducts research related to infectious diseases in the Republic of Congo. The CeRMI-CM conducted laboratory analyses and provided sample storage. The study used blood samples of consenting (or their primary caretakers consenting in the case of under-aged) HIV-positive patients living in Pointe-Noire, including children, adolescents and adults. All were followed up by specialists at the AAP, and each patient had detailed medical records from initial HIV positive-testing date up to the current study sample collection. 2.3. Ethical approval The study protocol was reviewed and approved by the institutional ethics committee of FCRM (n°034/CIE/FCRM/2021). Written informed consent was obtained from each adult patient or from parents or legal guardians of all under 18 years old in addition to providing an assent. All confidentiality measures and respect of scientific principals were applied in accordance with articles 21 and 22 of the Helsinki declaration. 2.4. Data and sample collection Patients were contacted and invited to AAP for an interview by a physician who is in regular contact with them. The purpose of the study was explained in detail by investigators (Supplementary material 01), and, after consenting (Supplementary materials 02 and 03), individual medical data were extracted from the AAP’s institutional medical record system. At the end of the interview, patient blood samples were collected by a trained technician. A venous blood sample (at least 5 mL in EDTA (Ethylene-Diamine-Tetra-Acetic)) from each patient was taken and recorded in strict compliance with patient anonymity and confidentiality guidelines. Socio-demographic data (age, sex, nationality, residence place, marital status and level of education) were collected. In terms of clinical data, we recorded pregnancy status, WHO clinical stage as assessed prior to this study, fever, cough, pleurisy, diarrhoea, vomiting, dermatitis, sexually transmitted infections (STIs), chronic cough, tuberculosis, genital herpes, pruritic dermatitis, shingles, Kaposi's disease, candidiasis and body mass index (BMI). Therapeutic characteristics collected included the duration (in years) between screening and treatment initiation, the number of ART doses per day, instances of missed medical follow-up and their duration, treatment interruptions, and poor compliance to treatment. 2.3. Sample treatment The full blood samples were centrifuged at 3500 rotations per minute (rpm) for 5 minutes after which plasma was aliquoted into 2 mL cryotubes, placed in boxes, and then stored at -20°C until they were transported to Brazzaville for molecular analysis. Plasma viral load was measured using Cepheid GeneXpert HIV-1 Viral Load DX (Sunnyvale, CA, USA) technology via real-time polymerase chain reaction (RT-qPCR), using a specific HIV cartridge, with a range of 20 to 10,000,000 RNA copies/mL. Any participant with a viral load above 1,000 RNA copies/mL after six months of treatment was defined as having a non-suppressed viral load status. 2.4 Statistical analysis Data were analysed using the statistical data processing software STATA (version 15.0, Statacorp LLC, TX, USA) and the figures were generated using the GraphPad Prism software (version 9.5.0 ,730). Means and standard deviations or medians with interquartile ranges were used to summarize the quantitative variables; while for qualitative variables, numbers and proportions were used. The comparison of the averages between the WHO clinical stages or body mass index was made using the One-way ANOVA test. We compared medians through the Median test with drop as condition. The proportions of qualitative variables between WHO clinical stages were compared using the Pearson chi-square test under the theoretical frequency condition greater than 5. When the condition was not met, the non-parametric Kruskal Wallis test was used as an alternative test. The association of all variables to viral suppression or not status was checked through bivariate logistic regression and crude odds ratios (ORs) with 95% confidence interval were estimated. However, only relevant associations were presented. An adjustment of the odds ratios was performed via multivariate logistic regression, for variables with a p-value <0.1; this is to avoid aberrant calculations. All tests were considered as statistically significant with a p-value < 0.05. 3. Results A total of 510 patients was included in the study (Table 1). The median age was 19.5 (1 - 73) years. Among them, 311/510 (61%) were women. Of the 311 women included in the study, 21 (6.8%) were pregnant. Patients came mainly from the Tié-tié (25.5%) district, followed by Loandjili (22.5%) and Ngoyo (19.5%) districts. The majority (402/510; 78.8%) was single. More than half (309/510; 60.6%) had completed secondary school; 38/510 (7.5%) had a university level education. Age-stratified analysis revealed distinct clinical patterns: stage II of the disease was mostly predominated among younger patients (1-17 years), while stage III was most common in the 18-50 year age group. The WHO stages were found to be related to the patient’s age category. Multivariate analysis showed a significant statistical association between age groups and their respective clinical stages (p = 0.022). No significant difference was observed with other variables tested as shown in Table 1. Table 2 describes clinical characteristics and clinical stages at the time of sample collection. All patients (100%) at stage III of HIV were affected by chronic cough, the difference was significant (p=0.003) between the three stages. Tuberculosis was found in 19% of HIV patients, with patients at stage III being mostly affected (p< 001). For oropharyngeal candidiasis, 6% of cases were reported among which 17% were at stage III (p=0.023). All the remaining symptomatic features assessed were not associated with any WHO clinical stage as shown in Table 2. The median viral load was 2,582 copies/mL (range 41 – 490000copies/mL). A total of 338/510 patients (66.3%) achieved undetectable viral load, whereas 107/510 (21.0%) showed no viral suppression (>1000) and 65/510 (12.7%) exhibited partial suppression (41-1000). With respect to WHO clinical staging, 448 patients (87.8%) were classified as stage I, while 33 (6.5%) and 29 (5.7%) were in stages II and III, respectively. Concerning nutritional status, 217 patients (42.5%) were underweight, and 214 (42.0%) had normal weight. Overweight and moderate obesity were less frequent, affecting 53 (10.4%) and 26 (5.1%) patients, respectively. Based on body mass index (BMI) distribution in this cohort, moderate obesity was the most frequent category (69%) and was significantly associated with patients aged 18–50 years (p < 0.0001). Among patients aged 1–17 years, underweight status predominated, accounting for 72% of cases. Matrimonial status was also significantly associated with a higher BMI (p < 0.0001). The majority of underweight patients (93%) and those with moderate obesity (62%) were single. A similar association was observed with educational level: across all BMI categories, most patients had attained secondary education compared to other levels, and this difference was statistically significant (p < 0.0001). By contrast, no significant associations were found between BMI and other variables such as gender, place of residence, or pregnancy status (Table 3). Regarding opportunistic diseases and symptoms in relation to body mass index (BMI), we observed that patients with a low BMI (underweight) were more likely to develop fever (Table 4) compared to those with normal weight or elevated BMI (overweight). Cough was also more common in underweight patients and those with moderate obesity, although chronic cough occurred predominantly among the underweight group. Genital herpes was reported in 26/510 (5.1%) patients overall. Its highest prevalence (17%) was found in overweight patients, and this difference was statistically significant compared with other BMI categories. Shingles was identified in 50 (9.8%) patients within the cohort of 510 individuals. Patients with moderate obesity were disproportionately affected with a statistically significant association observed (p = 0.011). Other symptoms and opportunistic infections have shown no significant associations with BMI categories, as detailed in Table 4. Figure 1 presents the distribution of antiretroviral therapy (ART) regimens used in the Republic of Congo according to WHO clinical stages. A total of 15 different regimens were identified. Among which, six regimens ( ABC+3TC+EFV, ABC+3TC+NVP, DTG+3TC+TDF, EFV+FTC+TDF, TDF+3TC+EFV, and TDF+FTC+EFV ) were classified as first-line antiretroviral therapies, eight regimens ( ABC+3TC+LPV/r, ABC+ddI+LPV/r, AZT+3TC, AZT+3TC+DTG, AZT+3TC+EFV, AZT+3TC+LPV/r, AZT+3TC+NVP , and TDF+FTC+LPV/r ) as second-line, and only one patient was receiving a third-line regimen ( DRV+RTV+RAL ). The majority 57% (291/510) of patients were treated with the first-line regimen: DTG+3TC+TDF (n=197), then by TDF+FTC+EFV (n=94) and the second line mostly used 15.5% (79/510) for treatment was ABC+3TC+LPV/r . More than 40 patients were treated with either TDF+FTC+LPV/r or AZT+3TC+NVP , while the remaining regimens were less prescribed for HIV patient treatment. Table 5 describes the statistical association between viral suppression and different characteristics collected during this study. Patients with a normal body mass index (BMI) had a significantly higher probability of achieving viral load suppression compared to those with a low BMI. Individuals with a low BMI were approximately twice as likely to fail to achieve viral load suppression as those with a normal or slightly higher weight. This difference remained statistically significant across groups and persisted after adjustment for confounders (AOR = 0.59; 95% CI: 0.35–0.98; p = 0.041). A prolonged delay between HIV diagnosis and treatment initiation was also associated with an increased risk of unsuppressed viral load. Patients who waited longer (more than five years) before starting ART up from timepoint of diagnosis were more likely to maintain a detectable viral load (OR = 2.33; 95% CI: 1.17–4.61; p = 0.015). However, this association lost statistical significance after adjustment for confounders (AOR = 1.93; 95% CI: 0.94–3.97;p = 0.073). Treatment interruption was strongly associated with the absence of viral suppression. Patients who discontinued ART were over three times more likely to maintain an unsuppressed viral load compared to those who continued treatment (AOR = 3.05; 95% CI: 1.65–5.62; p < 0.01). 4. Discussion This study highlighted the main characteristics of HIV infected patients on ART in the city of Pointe Noire in the Republic of Congo. We included 510 patients among which females were most strongly represented, demonstrating women as most vulnerable to acquiring HIV infections. This gender inequality can be explained by the social and behavioral factors like younger women having older male partners with higher HIV exposure [11]. A UNAIDS report revealed that in Sub-Saharan Africa, adolescent girls and young women are three times more likely to acquire HIV compared to males of the same age [12]. In addition, in this study the high prevalence of cases in stage II was reported in women, supporting the hypothesis of the vulnerability of women for HIV infection. Interestingly, more than 80% of cases from this study belonging to the earlier stage I which can be classified as the recent infection. Moreover, this early-stage predominance supports timely intervention opportunities and effective ART initiation to control disease progression and transmission [13, 14]. A total of 97/510 (19%) HIV patients was reported with tuberculosis co-infection, amongst which the high prevalence was found from patients in stage III of the disease. This is of note as active tuberculosis is already observable in higher frequency than in the non-HIV-positive population at relatively high CD4+ cell levels before cellular immunity grossly declines. The chronic cough as a possible symptom of tuberculosis infection was reported in high prevalence as well from patients in stage III of the disease irrespective of an established diagnosis or not. Tuberculosis and candidiasis are known as opportunistic diseases from HIV patients above all from those with weak immunity [15]. Indeed, tuberculosis testing for all HIV patients is an international policy and is part of the national HIV control programs. However, in the Republic of Congo there is no a systematic screening for TB in patients diagnosed with HIV. This lack of screening hinders the management and personalization of ART therapy, making it difficult to obtain optimal treatment outcomes. We reported that the BMI was significantly associated with age and educational level. A study conducted in USA on HIV-infected youth aged 10-19 [16] showed that HIV-infected Afro-American youth had significantly lower BMI scores compared to Afro-American national averages, indicating that growth and BMI can be impacted by HIV status in younger populations and age is a factor that can influence BMI changes. Accordingly, the normal BMI represented the optimal category for viral suppression, whereas patients with a lower BMI retained a twofold risk of maintaining a detectable viral load. A study [17] reported that HIV patients with normal BMI at baseline had better immune reconstitution and viral suppression outcomes after antiretroviral therapy (ART). Underweight patients (BMI <18.5) were at significantly higher risk of poor viral suppression and had a roughly 1.24 times higher adjusted hazard ratio to maintain detectable viral load compared to patients with normal BMI. It was demonstrated that HIV/AIDS patients receiving ART with higher baseline BMI had better immune reconstitution and that baseline BMI could be an important predictor of immune reconstitution in patients receiving ART [17]. The statistically significant association observed between matrimonial status and WHO clinical stage may reflect the role of social and family support in HIV management. Patients living in union (married or cohabiting) were more represented in advanced stages of the disease, which could suggest delayed diagnosis due to family responsibilities, social stigma, or underestimation of personal risk. Conversely, single patients, who predominated in early stages, may have benefited from earlier testing and linkage to care. Previous studies have shown that matrimonial status can influence adherence to treatment, disclosure of HIV status, and access to healthcare services, thereby impacting disease progression [18, 19]. This highlights the importance of integrating socio-behavioral factors, including family and community support, into HIV care and prevention strategies. In this study, included patients were mostly treated with the DTG+3TC+TDF combination as first-line ART. This regimen has been demonstrated to be associated with rapid HIV RNA decline, durable viral suppression, and low rates of resistance [20]. This regimen is strongly recommended by WHO as the preferred first-line ART for adults and adolescents living with HIV [21]. As it is known that the number of doses and amount of pills per day is an important challenge for HIV patients, this regimen has to be taken only once daily, which can further support the treatment adherence for this population. Our analysis further showed that treatment interruption was strongly associated with the maintenance of unsuppressed viral load. It has been shown that when patients discontinue therapy, the immediate consequence was the rapid decline of antiretroviral drug levels, allowing active viral replication to resume [22]. This uncontrolled replication contributes to viral rebound, which has multiple clinical and public health implications. First, it substantially increases the risk of opportunistic infections, as the immune system becomes progressively weakened. Second, elevated viral load during rebound enhances the probability of onward HIV transmission to sexual partners or through other routes of exposure. In addition to these immediate risks, treatment interruption also drives the selection of resistant viral strains. Because replication occurs in the presence of suboptimal or waning drug concentrations, resistant variants are more likely to emerge. This not only compromises the effectiveness of the current regimen but also limits the options available for future treatment, particularly in resource-limited settings where access to second or third-line therapies is restricted [23]. Taken together, these findings underscore the critical importance of sustained adherence to ART, both for individual clinical outcomes and for broader epidemic control. The only limitation that should be highlighted for this study; the aspect of CD4 counting has been not considered which can help to understand very well the relationship between the viral load suppression and weakness of the immune system of infected people. Conclusion In conclusion, we found that patients who initiated ART therapy between five and ten years after testing HIV positive were more likely to have an unsuppressed viral load and to present with advanced clinical stages, compared to those who started treatment within five months. A variety of factors, including tuberculosis, candidiasis, treatment interruption, underweight and delaying antiretroviral treatment initiation were significantly associated with the disease severity. Regular monitoring of these factors will be essential for tracking HIV/AIDS status and improving patient management and clinical counseling. Future studies should include subjects with different ethnic backgrounds, and functional evaluation could be used to examine the relationship between predictive factors and the progression of HIV/AIDS. Abbreviations 3TC: Lamivudine AAP : Association Avenir Positif ABC: Abacavir AIDS : Acquired Immunodeficiency Syndrome AOR: Adjusted Odds Ratio ART : Anti-Retroviral Therapy AZT : Zidovudine or Azidothymidine BMI : Body Mass Index CeRMI-CM : Centre de Recherche sur les Maladies Infectieuses Christophe Mérieux ddI : Didanosine DRV : Darunavir DTG : Dolutegravir EDTA: Ethylene-Diamine-Tetra-Acetic EFV: Efavirenz FCRM : Fondation Congolaise pour la Recherche Médicale FTC : Emtricitabine HIV : Human Immunodeficiency Virus LPV/r: Lopinavir/Ritonavir NVP : Nevirapine OR : Odds Ration RAL : Raltegravir RT-qPCR: Real Time quantitative Polymerase Chain Reaction RTV : Ritonavir SD : Standard Deviation STI: Sexually Transmitted Infections TDF : Tenofovir Disoproxil Fumarate UNAIDS : United Nation programme on HIV/AIDS WHO : World Health Organization Declarations Funding information This research was funded by grants from CANTAM (EDCTP-CSA2020NoE-3100). The funders had no role in the design, analysis, or decision to submit this manuscript. Declaration of author contribution FN supervised the overall work. FN, AMM, MPG and DM were involved in the study design. AMEI, CCMM, LMM, EPOM and FHM were involved in sample collection and analysis. Data analysis was performed by JCV and CCMM. All authors contributed to the manuscript. All authors reviewed and approved the final manuscript. Declaration of competing interest All authors declare no conflict of interest Declaration of AI use Artificial intelligence (AI) tools, specifically ChatGPT and Perplexity developed by OpenAI, were used to search specific cited articles, summarize litterature and check grammar. All content was subsequently reviewed and edited by the authors to ensure accuracy and originality. The authors take full responsibility for the final version of the manuscript. Acknowledgments We thank the staff of the Centre Avenir Positif and all HIV patients and their families who participated in this study. We also thank Adrian J.F. Luty for help with manuscript preparation. Declaration of Human Ethics and Consent to Participate The study protocol was reviewed and approved by the institutional ethics committee of FCRM (n°034/CIE/FCRM/2021). Written informed consent was obtained from each adult patient or from parents or legal guardians of all under 18 years old in addition to providing an assent. Clinical trial number : not applicable. References Patrias K, W.D., HIV and Infections. Medline plus, 2007. ONUSIDA, Fiche d'information — Dernières statistiques sur l'état de l'épidémie de sida. Disponible en ligne: https://www.unaids.org/fr/resources/fact-sheet (consulté le 17 janvier 2025). WHO, Global Action Plan on HIV Drug Resistance 2017-2021 Genève, WHO [en ligne] http://apps.who.int/iris/bitstream/10665/255883/1/9789241512848-eng.pdf?ua=1 (page consultée le 19/01/2025). MSF, Untangling the web of antiretroviral price reduction 18th Edition-July 2016, rapport MSF, Genève [en ligne], https://msfaccess.org/sites/default/files/HIV_report_Untangling-the-web-18thed_ENG_2016.pdf (page consultée le 19/01/2025). Luo, H., M. Sun, and J. Du, Associated factors for progression to AIDS among HIV-infected people who use drugs: a retrospective cohort study in Dongguan, China. BMJ Open, 2019. 9 (7): p. e023841. UNAIDS, Country factsheets Congo, HIV and AIDS Estimates. Google, 2023. UNAIDS, Country factsheets, Congo 2024 , in Google . 2025. population, M.d.l.s.e.d.l., Message du gouvernement à l’occasion de la célébration de la 34e journée mondiale de lutte contre le vih/sida.Le 1er décembre 2022. Disponible en ligne: https://sante.gouv.cg/message-du-gouvernement-2/ ( consulté le 18 janvier 2025). WHO, A.r., Country Disease Outlook, Congo. Google, 2023. Widdowson, M.A., et al., Outbreaks of acute gastroenteritis on cruise ships and on land: identification of a predominant circulating strain of norovirus--United States, 2002. J Infect Dis, 2004. 190 (1): p. 27-36. Magadi, M.A., Understanding the gender disparity in HIV infection across countries in sub-Saharan Africa: evidence from the Demographic and Health Surveys. Sociol Health Illn, 2011. 33 (4): p. 522-39. healthcare, G.V., HIV IN WOMEN. Google, 2023. Rosenberg, N.E., HIV testing to the test: does HIV testing promote HIV prevention in HIV-uninfected adults? Sex Transm Infect, 2016. 92 (8): p. 566-567. Rosenberg, N.E., et al., The effect of HIV counselling and testing on HIV acquisition in sub-Saharan Africa: a systematic review. Sex Transm Infect, 2016. 92 (8): p. 579-586. Riccardi, N., G.A. Rotulo, and E. Castagnola, Definition of Opportunistic Infections in Immunocompromised Children on the Basis of Etiologies and Clinical Features: A Summary for Practical Purposes. Curr Pediatr Rev, 2019. 15 (4): p. 197-206. Arbeitman, L.E., et al., Body mass index and waist circumference of HIV-infected youth in a Miami cohort: comparison to local and national cohorts. J Pediatr Gastroenterol Nutr, 2014. 59 (4): p. 449-54. Zhu, J., et al., High baseline body mass index predicts recovery of CD4+ T lymphocytes for HIV/AIDS patients receiving long-term antiviral therapy. PLoS One, 2022. 17 (12): p. e0279731. Mirzaei-Alavijeh, M., et al., Insights into medication adherence among HIV-positive patients: the integrated change model. AIDS Res Ther, 2025. 22 (1): p. 66. Gutin, S.A., et al., Supportive couple relationships buffer against the harms of HIV stigma on HIV treatment adherence. BMC Public Health, 2023. 23 (1): p. 1878. Nye, J., First-line ART regimen DTG/3TC efficacious in adults with high HIV viral load. HIV and Co-Infections News, 2025. , W.H.O., UPDATE ON THE TRANSITION TO DOLUTEGRAVIR-BASED ANTIRETROVIRAL THERAPY: REPORT OFA WHO MEETING . 2022. Guy, R., et al., Antiretroviral treatment interruption and loss to follow-up in two HIV cohorts in Australia and Asia: implications for 'test and treat' prevention strategy. AIDS Patient Care STDS, 2013. 27 (12): p. 681-91. UNAIDS, Q&A on the impact of the interruption of treatment for people living with HIV . 2025. Tables Tables 1 to 5 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Elengaetal2025Supplementarymaterial02.docx Elengaetal2025Supplementarymatrial01.docx Elengaetal2025Supplementarymaterial03.docx Tables.docx Cite Share Download PDF Status: Published Journal Publication published 08 Jan, 2026 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 28 Oct, 2025 Reviews received at journal 27 Oct, 2025 Reviews received at journal 24 Oct, 2025 Reviewers agreed at journal 19 Oct, 2025 Reviewers agreed at journal 15 Oct, 2025 Reviewers agreed at journal 07 Oct, 2025 Reviewers invited by journal 25 Sep, 2025 Editor assigned by journal 25 Sep, 2025 Editor invited by journal 23 Sep, 2025 Submission checks completed at journal 21 Sep, 2025 First submitted to journal 21 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7622263","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":525969043,"identity":"c37fd558-e44c-4780-ab0b-1cbb1bc43f91","order_by":0,"name":"Arcy Marcelin Elenga Ike","email":"","orcid":"","institution":"Congolese Foundation for Medical Research","correspondingAuthor":false,"prefix":"","firstName":"Arcy","middleName":"Marcelin Elenga","lastName":"Ike","suffix":""},{"id":525969044,"identity":"ce031c8d-c101-4ff4-8261-74a9f065445c","order_by":1,"name":"Claujens Chastel Mfoutou Mapanguy","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDklEQVRIiWNgGAWjYDACCTBpAefLgYgDDwhpOQDVCALGYC0JpGhJbACR+LTwz25+/PlDhUQ0kPHs4de2w+nzww4/BNpiJ6fbgMOSO8fMJA6ckcidceeYubFs2+HcjbfTDIBako3NDmDXYiCRYMZwsE0it+FGgpm0JEjL7ASQlgOJ23BqSf/84eA/idz5N9K/gbSkG85O/0BAS46BxMEGidwNN3LMJD+2HU6Ql87Bb4vEjZwyiTPHJHI33jlTJs1wLt1wg3ROwYEEA9x+4Z+RvvlDRY1N7rzb7dskf5RZy8vPBop8qLCTw6UFyT4GBmYehmYGA7BKA0LKoVoYfzDUMcg3EKN6FIyCUTAKRhIAAEh9afICQgI9AAAAAElFTkSuQmCC","orcid":"","institution":"Congolese Foundation for Medical Research","correspondingAuthor":true,"prefix":"","firstName":"Claujens","middleName":"Chastel Mfoutou","lastName":"Mapanguy","suffix":""},{"id":525969045,"identity":"f9b5ad24-9c74-4563-8f06-de28ef37bd55","order_by":2,"name":"Jeannhey Christevy Vouvoungui","email":"","orcid":"","institution":"Congolese Foundation for Medical Research","correspondingAuthor":false,"prefix":"","firstName":"Jeannhey","middleName":"Christevy","lastName":"Vouvoungui","suffix":""},{"id":525969046,"identity":"3c95f9a6-24e0-4d68-86aa-41ddcfc6a2f6","order_by":3,"name":"Freisnel Hermeland Mouzinga","email":"","orcid":"","institution":"Congolese Foundation for Medical Research","correspondingAuthor":false,"prefix":"","firstName":"Freisnel","middleName":"Hermeland","lastName":"Mouzinga","suffix":""},{"id":525969047,"identity":"de8a86b0-5175-4c73-ac0d-84a48520e247","order_by":4,"name":"Landry Martial Miguel","email":"","orcid":"","institution":"Faculty of Health Sciences, Marien Ngouabi University","correspondingAuthor":false,"prefix":"","firstName":"Landry","middleName":"Martial","lastName":"Miguel","suffix":""},{"id":525969048,"identity":"d2eca973-fa18-40f3-bac1-20b91ece0284","order_by":5,"name":"Esther Paule Oyaba Molenga","email":"","orcid":"","institution":"Congolese Foundation for Medical Research","correspondingAuthor":false,"prefix":"","firstName":"Esther","middleName":"Paule Oyaba","lastName":"Molenga","suffix":""},{"id":525969049,"identity":"7beb5534-0517-4728-ad4c-00700cdbb062","order_by":6,"name":"Alexia Fila","email":"","orcid":"","institution":"Association Avenir Positif, Pointe-Noire","correspondingAuthor":false,"prefix":"","firstName":"Alexia","middleName":"","lastName":"Fila","suffix":""},{"id":525969051,"identity":"a4e292d5-064c-42ea-9f56-ae26d3e60f63","order_by":7,"name":"Alain Maxime Mouanga","email":"","orcid":"","institution":"Congolese Foundation for Medical Research","correspondingAuthor":false,"prefix":"","firstName":"Alain","middleName":"Maxime","lastName":"Mouanga","suffix":""},{"id":525969052,"identity":"fee6bf4f-a72d-4bd4-a111-127b13d27416","order_by":8,"name":"Martin Peter Grobusch","email":"","orcid":"","institution":"Amsterdam University Medical Centers, University of Amsterdam","correspondingAuthor":false,"prefix":"","firstName":"Martin","middleName":"Peter","lastName":"Grobusch","suffix":""},{"id":525969054,"identity":"29651cac-300c-41f9-8daa-489ba9158436","order_by":9,"name":"Donatien Moukassa","email":"","orcid":"","institution":"Faculty of Health Sciences, Marien Ngouabi University","correspondingAuthor":false,"prefix":"","firstName":"Donatien","middleName":"","lastName":"Moukassa","suffix":""},{"id":525969056,"identity":"add70a1a-9412-4d3e-b70a-2f0c7bd39c08","order_by":10,"name":"Francine Ntoumi","email":"","orcid":"","institution":"Congolese Foundation for Medical Research","correspondingAuthor":false,"prefix":"","firstName":"Francine","middleName":"","lastName":"Ntoumi","suffix":""}],"badges":[],"createdAt":"2025-09-15 15:23:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7622263/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7622263/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-025-12178-6","type":"published","date":"2026-01-08T15:59:30+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":93030816,"identity":"4bab9637-33aa-4a60-ad88-d708e4020288","added_by":"auto","created_at":"2025-10-08 10:09:02","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":149235,"visible":true,"origin":"","legend":"","description":"","filename":"Elengaetal2025HIVFinalManuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-7622263/v1/7e34a728e5cc7be19291cf4a.docx"},{"id":93029863,"identity":"6ca570b6-7e69-4400-8144-4139e337b981","added_by":"auto","created_at":"2025-10-08 10:01:02","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":11533,"visible":true,"origin":"","legend":"","description":"","filename":"cf440932aa1846089f20720cdde531a8.json","url":"https://assets-eu.researchsquare.com/files/rs-7622263/v1/6dd1f8ec35915794c0faeaab.json"},{"id":93028417,"identity":"307c3b04-55d0-4e18-8554-36666882104d","added_by":"auto","created_at":"2025-10-08 09:53:02","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":30141,"visible":true,"origin":"","legend":"","description":"","filename":"Elengaetal2025Supplementarymaterial02.docx","url":"https://assets-eu.researchsquare.com/files/rs-7622263/v1/f289bd68aa0e7c84f8d738d1.docx"},{"id":93028422,"identity":"e015a13e-8a7a-4b5c-ab16-b3794dd71611","added_by":"auto","created_at":"2025-10-08 09:53:02","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":24485,"visible":true,"origin":"","legend":"","description":"","filename":"Elengaetal2025Supplementarymaterial03.docx","url":"https://assets-eu.researchsquare.com/files/rs-7622263/v1/dbfd741256c616832b4fcfd2.docx"},{"id":93028424,"identity":"b7617e2d-46ef-4cc4-b28f-975166c61568","added_by":"auto","created_at":"2025-10-08 09:53:02","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":31208,"visible":true,"origin":"","legend":"","description":"","filename":"Elengaetal2025Supplementarymatrial01.docx","url":"https://assets-eu.researchsquare.com/files/rs-7622263/v1/84da98d371d45422b78c4238.docx"},{"id":93028426,"identity":"334cd27b-7b52-4751-a4be-d4d20b67f9d7","added_by":"auto","created_at":"2025-10-08 09:53:02","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":121085,"visible":true,"origin":"","legend":"","description":"","filename":"cf440932aa1846089f20720cdde531a81enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7622263/v1/10a76514eac5df89a15c7d77.xml"},{"id":93028428,"identity":"85cf581f-27fc-4c1c-bb91-8d601cf94bcd","added_by":"auto","created_at":"2025-10-08 09:53:02","extension":"emf","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":159468,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.emf","url":"https://assets-eu.researchsquare.com/files/rs-7622263/v1/666cc2ab6941f5e9d14308f9.emf"},{"id":93029868,"identity":"815fea8c-bc27-456f-b239-5fb8ca4052e7","added_by":"auto","created_at":"2025-10-08 10:01:02","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":19058,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7622263/v1/3ac80b95b9d23d8a42bd1205.png"},{"id":93028429,"identity":"b7b6a223-5703-40f8-8002-8b77080b5b39","added_by":"auto","created_at":"2025-10-08 09:53:02","extension":"xml","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":118808,"visible":true,"origin":"","legend":"","description":"","filename":"cf440932aa1846089f20720cdde531a81structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7622263/v1/c8dfab99b812634c3d42ccd6.xml"},{"id":93028427,"identity":"fe1d0803-7fa3-49a8-91a9-ff9dba174967","added_by":"auto","created_at":"2025-10-08 09:53:02","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":130645,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7622263/v1/30111383e51bd893f6c4ac03.html"},{"id":93028414,"identity":"2404acfd-329a-41ac-85e5-ef04a94d9db2","added_by":"auto","created_at":"2025-10-08 09:53:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":25362,"visible":true,"origin":"","legend":"\u003cp\u003eA - Distribution of patients by treatment regimen. B – Mean of log viral load according to treatment regimen.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7622263/v1/b662c1cf4ae99d15bbb3b2c8.png"},{"id":100069470,"identity":"5205d5a5-f6c3-417c-be79-3f6ec421bedf","added_by":"auto","created_at":"2026-01-12 16:14:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":655419,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7622263/v1/cb5eb2c3-14c4-4818-978b-b257ccd38ed0.pdf"},{"id":93030815,"identity":"bf7cfc76-3b28-47ad-abaf-651a03587441","added_by":"auto","created_at":"2025-10-08 10:09:02","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":30141,"visible":true,"origin":"","legend":"","description":"","filename":"Elengaetal2025Supplementarymaterial02.docx","url":"https://assets-eu.researchsquare.com/files/rs-7622263/v1/7b8c25245e8393dc86067a52.docx"},{"id":93029865,"identity":"57d10083-604e-4fb0-92c2-6c1b0e3cfd9d","added_by":"auto","created_at":"2025-10-08 10:01:02","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":31208,"visible":true,"origin":"","legend":"","description":"","filename":"Elengaetal2025Supplementarymatrial01.docx","url":"https://assets-eu.researchsquare.com/files/rs-7622263/v1/f88a0120abb37a74906918e9.docx"},{"id":93028420,"identity":"52feb530-47ba-48f7-970d-8e875b7285ea","added_by":"auto","created_at":"2025-10-08 09:53:02","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":24485,"visible":true,"origin":"","legend":"","description":"","filename":"Elengaetal2025Supplementarymaterial03.docx","url":"https://assets-eu.researchsquare.com/files/rs-7622263/v1/4c5cd53b2c10f9ac955dcfae.docx"},{"id":93029866,"identity":"ad60081b-5483-4457-93b8-fd3796777e23","added_by":"auto","created_at":"2025-10-08 10:01:02","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":39740,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7622263/v1/5fd5495396f4d0a43ade355d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Epidemiological characteristics of people living with HIV on antiretroviral therapy (ART) in Pointe-Noire, Republic of Congo","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eHuman immunodeficiency virus (HIV) infection and subsequent progression to AIDS with the development of opportunistic infections remains a serious public health problem worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. UNAIDS reported in 2024 that there were approximately 39.9\u0026nbsp;million people living with HIV around the world [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. For decades, infection with HIV was considered as an invariably fatal, life span-limiting disease. Now the infection is manageable with an appropriate antiretroviral therapy (ART), facilitating long-term if not life-long prevention of disease progression; though there is still no cure.\u003c/p\u003e\u003cp\u003eThe severity of HIV infection varies according to several factors including human-host, viral, and environmental factors. The World Health Organization (WHO) issued recommendations for the management of HIV/AIDS [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], and categorized the disease into three levels or stages (from stages 1 to 3). In that nomenclature, stage 1 corresponds to the asymptomatic phase; stage 2 corresponds to the acute phase of the disease; and stage 3 corresponds to the AIDS phase of the disease [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Treatment failure has also been shown to influence the progression of an HIV infection to AIDS. In addition, factors such as viral genetics, host immune responses, environmental co-factors, the mechanism of ART drugs action, patients' difficulties in adhering to medical prescriptions, and healthcare system weaknesses were also found to be associated with HIV progression to AIDS. For instance, a study conducted in China among HIV-infected patient on ART reported a significant association between higher baseline CD4 T-cell counts and adherence to ART and non-progression of HIV to AIDS, whilst older age at diagnosis (up to 36 years) and marital status were associated with increased probability to advance to AIDS [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Understanding these factors is essential for developing personalized treatment plans and implementing adapted public health strategies for efficient HIV epidemic management tailored to local circumstances.\u003c/p\u003e\u003cp\u003eIn 2023; of approximately 120,000 people living with HIV in the Republic of Congo, only 38,000 (31.6%) were on ART [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. According to a recent UNAIDS report (2024), the prevalence of HIV in the adult Congolese population was approximately 3.4%, with more women than men being (sex ratio 2.4) infected, and only 35% of people living with HIV knowing their status [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Currently, the country is still far from achieving at least one of the three WHO 95-95-95 goals [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. There is limited data on the characteristics of HIV patients receiving ART in the Republic of Congo, particularly regarding the proportion achieving viral suppression, which is a key indicator for monitoring treatment effectiveness and epidemic control. In addition, few studies have systematically examined the socio-demographic, clinical, and treatment-related factors associated with viral suppression in this context. The present epidemiological study describes the characteristics of HIV patients under ART and identifies factors associated with viral load suppression in this Congolese population.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1. Study type and period\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a cross-sectional study conducted in HIV patient population with one point contact in time according to their previous WHO stage. The study was conducted from June to July 2021 in Pointe-Noire, Republic of Congo.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2. Site and study population\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted at the\u0026nbsp;centre of the \u0026lsquo;Association Avenir\u0026nbsp;Positif\u0026rsquo; (AAP) in Pointe Noire, with support from\u0026nbsp;the\u0026nbsp;\u0026lsquo;Centre de recherche sur les maladies infectieuses Chistophe-M\u0026eacute;rieux\u0026rsquo;\u0026nbsp;(CeRMI-CM) in Brazzaville, thus\u0026nbsp;located in the\u0026nbsp;economic and political\u0026nbsp;capital\u0026nbsp;cities,\u0026nbsp;of the Republic of Congo, respectively. The AAP is a non-profit association set up in 2007 in Pointe-Noire by parents of HIV positive children, with the aim of improving the children quality of life including adolescents and young people.\u0026nbsp;This centre\u0026nbsp;was used\u0026nbsp;for\u0026nbsp;patient enrolment, data and sample collection.\u0026nbsp;The City of\u0026nbsp;Pointe-Noire\u0026nbsp;is divided into six districts, with\u0026nbsp;a population of over 1.1 million inhabitants out of the 6.1 million countrywide\u0026nbsp;[10].\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;\u0026lsquo;Centre de recherche sur les maladies infectieuses Chistophe-M\u0026eacute;rieux (CeRMI-CM)\u0026rsquo; was created in Brazzaville by the Congolese Foundation for Medical Research (FCRM) in 2018. It conducts research related to infectious diseases in the Republic of Congo. The CeRMI-CM conducted laboratory analyses and provided sample storage.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study\u0026nbsp;used blood samples of consenting (or their primary caretakers consenting in the case of under-aged)\u0026nbsp;HIV-positive patients living in Pointe-Noire, including\u0026nbsp;children,\u0026nbsp;adolescents\u0026nbsp;and adults. All\u0026nbsp;were followed up\u0026nbsp;by specialists\u0026nbsp;at the\u0026nbsp;AAP, and\u0026nbsp;each patient\u0026nbsp;had detailed\u0026nbsp;medical records from\u0026nbsp;initial\u0026nbsp;HIV\u0026nbsp;positive-testing date\u0026nbsp;up\u0026nbsp;to the current\u0026nbsp;study\u0026nbsp;sample collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. Ethical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was reviewed and approved by the institutional ethics committee of FCRM (n\u0026deg;034/CIE/FCRM/2021).\u0026nbsp;Written informed consent was obtained from each adult patient or from parents or legal guardians of all under 18 years old in addition to providing an assent. All confidentiality measures and respect of scientific principals were applied in accordance with articles 21 and 22 of the\u0026nbsp;Helsinki declaration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4. Data and sample collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients were\u0026nbsp;contacted and\u0026nbsp;invited\u0026nbsp;to AAP\u0026nbsp;for\u0026nbsp;an\u0026nbsp;interview\u0026nbsp;by a physician who is in regular contact with them.\u0026nbsp;The purpose of the study was explained in detail by investigators (Supplementary material 01),\u0026nbsp;and,\u0026nbsp;after\u0026nbsp;consenting (Supplementary materials 02 and 03), individual\u0026nbsp;medical data were extracted from the\u0026nbsp;AAP\u0026rsquo;s\u0026nbsp;institutional medical\u0026nbsp;record system. At the end of the interview,\u0026nbsp;patient blood samples were collected by a trained technician. A venous\u0026nbsp;blood sample\u0026nbsp;(at least 5 mL in EDTA (Ethylene-Diamine-Tetra-Acetic)) from each patient was taken and recorded in strict compliance with patient anonymity and confidentiality guidelines. Socio-demographic data (age, sex, nationality, residence place, marital status and level of education)\u0026nbsp;were collected.\u0026nbsp;In terms of\u0026nbsp;clinical\u0026nbsp;data,\u0026nbsp;we\u0026nbsp;recorded pregnancy status, WHO clinical stage\u0026nbsp;as assessed prior to this study,\u0026nbsp;fever, cough, pleurisy, diarrhoea, vomiting, dermatitis, sexually transmitted infections (STIs), chronic cough, tuberculosis, genital herpes, pruritic dermatitis, shingles, Kaposi\u0026apos;s disease, candidiasis and body mass index (BMI).\u0026nbsp;Therapeutic characteristics\u0026nbsp;collected included\u0026nbsp;the duration (in years) between screening and treatment initiation, the number of ART doses per day, instances of\u0026nbsp;missed\u0026nbsp;medical follow-up\u0026nbsp;and their\u0026nbsp;duration,\u0026nbsp;treatment interruptions,\u0026nbsp;and poor compliance to\u0026nbsp;treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. Sample treatment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe full blood samples\u0026nbsp;were centrifuged at 3500 rotations per minute (rpm) for 5 minutes\u0026nbsp;after which\u0026nbsp;plasma was aliquoted into 2 mL cryotubes, placed in boxes, and then\u0026nbsp;stored at -20\u0026deg;C until\u0026nbsp;they were transported\u0026nbsp;to Brazzaville for molecular analysis.\u003c/p\u003e\n\u003cp\u003ePlasma viral load was measured using Cepheid GeneXpert HIV-1 Viral Load DX (Sunnyvale, CA, USA) technology\u0026nbsp;via\u0026nbsp;real-time polymerase chain reaction (RT-qPCR),\u0026nbsp;using a\u0026nbsp;specific HIV\u0026nbsp;cartridge, with a range of 20 to\u0026nbsp;10,000,000\u0026nbsp;RNA copies/mL.\u003c/p\u003e\n\u003cp\u003eAny participant with a viral load above\u0026nbsp;1,000\u0026nbsp;RNA copies/mL after six\u0026nbsp;months of\u0026nbsp;treatment was\u0026nbsp;defined as having a\u0026nbsp;non-suppressed viral load status.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Statistical analysis\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData were analysed using the statistical data processing software STATA (version 15.0, Statacorp LLC, TX, USA) and the figures were generated using the GraphPad Prism software (version 9.5.0 ,730). Means and standard deviations or medians with interquartile ranges were used to summarize the quantitative variables; while for qualitative variables, numbers and proportions were used. The comparison of the averages between the WHO clinical stages or body mass index was made using the One-way ANOVA test. We compared medians through the Median test with drop as condition. The proportions of qualitative variables between WHO clinical stages were compared using the Pearson chi-square test under the theoretical frequency condition greater than 5. When the condition was not met, the non-parametric Kruskal Wallis test was used as an alternative test. The association of all variables to viral suppression or not status was checked through bivariate logistic regression and crude odds ratios (ORs) with 95% confidence interval were estimated. However, only relevant associations were presented. An adjustment of the odds ratios was performed via multivariate logistic regression, for variables with a p-value \u0026lt;0.1; this is to avoid aberrant calculations. All tests were considered as statistically significant with a p-value \u0026lt; 0.05.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eA total of 510 patients was included in the study (Table 1). The median age was 19.5 (1 - 73) years. Among them, 311/510 (61%) were women. Of the 311 women included in the study, 21 (6.8%) were pregnant. Patients came mainly from the Ti\u0026eacute;-ti\u0026eacute; (25.5%) district, followed by Loandjili (22.5%) and Ngoyo (19.5%) districts. The majority (402/510; 78.8%) was single. More than half (309/510; 60.6%) had completed secondary school; 38/510 (7.5%) had a university level education. Age-stratified analysis revealed distinct clinical patterns: stage II of the disease was mostly predominated among younger patients (1-17 years), while stage III was most common in the 18-50 year age group. The WHO stages were found to be related to the patient\u0026rsquo;s age category. Multivariate analysis showed a significant statistical association between age groups and their respective clinical stages (p = 0.022). No significant difference was observed with other variables tested as shown in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 2 describes clinical characteristics and clinical stages at the time of sample collection. All patients (100%) at stage III of HIV were affected by chronic cough, the difference was significant (p=0.003) between the three stages. Tuberculosis was found in 19% of HIV patients, with patients at stage III being mostly affected (p\u0026lt; 001). For oropharyngeal candidiasis, 6% of cases were reported among which 17% were at stage III (p=0.023). All the remaining symptomatic features assessed were not associated with any WHO clinical stage as shown in Table 2.\u003c/p\u003e\n\u003cp\u003eThe median viral load was 2,582 copies/mL (range 41 \u0026ndash; 490000copies/mL). A total of 338/510 patients (66.3%) achieved undetectable viral load, whereas 107/510 (21.0%) showed no viral suppression (\u0026gt;1000) and 65/510 (12.7%) exhibited partial suppression (41-1000). With respect to WHO clinical staging, 448 patients (87.8%) were classified as stage I, while 33 (6.5%) and 29 (5.7%) were in stages II and III, respectively. Concerning nutritional status, 217 patients (42.5%) were underweight, and 214 (42.0%) had normal weight. Overweight and moderate obesity were less frequent, affecting 53 (10.4%) and 26 (5.1%) patients, respectively.\u003c/p\u003e\n\u003cp\u003eBased on body mass index (BMI) distribution in this cohort, moderate obesity was the most frequent category (69%) and was significantly associated with patients aged 18\u0026ndash;50 years (p \u0026lt; 0.0001). Among patients aged 1\u0026ndash;17 years, underweight status predominated, accounting for 72% of cases. Matrimonial status was also significantly associated with a higher BMI (p \u0026lt; 0.0001). The majority of underweight patients (93%) and those with moderate obesity (62%) were single. A similar association was observed with educational level: across all BMI categories, most patients had attained secondary education compared to other levels, and this difference was statistically significant (p \u0026lt; 0.0001). By contrast, no significant associations were found between BMI and other variables such as gender, place of residence, or pregnancy status (Table 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding opportunistic diseases and symptoms in relation to body mass index (BMI), we observed that patients with a low BMI (underweight) were more likely to develop fever (Table 4) compared to those with normal weight or elevated BMI (overweight). Cough was also more common in underweight patients and those with moderate obesity, although chronic cough occurred predominantly among the underweight group.\u003c/p\u003e\n\u003cp\u003eGenital herpes was reported in 26/510 (5.1%) patients overall. Its highest prevalence (17%) was found in overweight patients, and this difference was statistically significant compared with other BMI categories. Shingles was identified in 50 (9.8%) patients within the cohort of 510 individuals. Patients with moderate obesity were disproportionately affected with a statistically significant association observed (p = 0.011). Other symptoms and opportunistic infections have shown no significant associations with BMI categories, as detailed in Table 4.\u003c/p\u003e\n\u003cp\u003eFigure 1 presents the distribution of antiretroviral therapy (ART) regimens used in the Republic of Congo according to WHO clinical stages. A total of 15 different regimens were identified. Among which, six regimens (\u003cem\u003eABC+3TC+EFV, ABC+3TC+NVP, DTG+3TC+TDF, EFV+FTC+TDF, TDF+3TC+EFV,\u003c/em\u003e and \u003cem\u003eTDF+FTC+EFV\u003c/em\u003e) were classified as first-line antiretroviral therapies, eight regimens (\u003cem\u003eABC+3TC+LPV/r, ABC+ddI+LPV/r, AZT+3TC, AZT+3TC+DTG, AZT+3TC+EFV, AZT+3TC+LPV/r, AZT+3TC+NVP\u003c/em\u003e, and \u003cem\u003eTDF+FTC+LPV/r\u003c/em\u003e) as second-line, and only one patient was receiving a third-line regimen (\u003cem\u003eDRV+RTV+RAL\u003c/em\u003e). The majority 57% (291/510) of patients were treated with the first-line regimen: \u003cem\u003eDTG+3TC+TDF\u0026nbsp;\u003c/em\u003e(n=197), then by \u003cem\u003eTDF+FTC+EFV\u003c/em\u003e (n=94) and the second line mostly used 15.5% (79/510) for treatment was \u003cem\u003eABC+3TC+LPV/r\u003c/em\u003e. More than 40 patients were treated with either \u003cem\u003eTDF+FTC+LPV/r\u003c/em\u003e or \u003cem\u003eAZT+3TC+NVP\u003c/em\u003e, while the remaining regimens were less prescribed for HIV patient treatment.\u003c/p\u003e\n\u003cp\u003eTable 5 describes the statistical association between viral suppression and different characteristics collected during this study. Patients with a normal body mass index (BMI) had a significantly higher probability of achieving viral load suppression compared to those with a low BMI. Individuals with a low BMI were approximately twice as likely to fail to achieve viral load suppression as those with a normal or slightly higher weight. This difference remained statistically significant across groups and persisted after adjustment for confounders (AOR = 0.59; 95% CI: 0.35\u0026ndash;0.98; p = 0.041).\u003c/p\u003e\n\u003cp\u003eA prolonged delay between HIV diagnosis and treatment initiation was also associated with an increased risk of unsuppressed viral load. Patients who waited longer (more than five years) before starting ART up from timepoint of diagnosis were more likely to maintain a detectable viral load (OR = 2.33; 95% CI: 1.17\u0026ndash;4.61; p = 0.015). However, this association lost statistical significance after adjustment for confounders (AOR = 1.93; 95% CI: 0.94\u0026ndash;3.97;p = 0.073).\u003c/p\u003e\n\u003cp\u003eTreatment interruption was strongly associated with the absence of viral suppression. Patients who discontinued ART were over three times more likely to maintain an unsuppressed viral load compared to those who continued treatment (AOR = 3.05; 95% CI: 1.65\u0026ndash;5.62; p \u0026lt; 0.01).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study highlighted the main characteristics of HIV infected patients on ART in the city of Pointe Noire in the Republic of Congo. We included 510 patients among which females were most strongly represented, demonstrating women as most vulnerable to acquiring HIV infections. This gender inequality can be explained by the social and behavioral factors like younger women having older male partners with higher HIV exposure [11]. A UNAIDS report revealed that in Sub-Saharan Africa, adolescent girls and young women are three times more likely to acquire HIV compared to males of the same age [12]. In addition, in this study the high prevalence of cases in stage II was reported in women, supporting the hypothesis of the vulnerability of women for HIV infection. Interestingly, more than 80% of cases from this study belonging to the earlier stage I which can be classified as the recent infection. Moreover, this early-stage predominance supports timely intervention opportunities and effective ART initiation to control disease progression and transmission [13, 14].\u003c/p\u003e\n\u003cp\u003eA total of 97/510 (19%) HIV patients was reported with tuberculosis co-infection, amongst which the high prevalence was found from patients in stage III of the disease. This is of note as active tuberculosis is already observable in higher frequency than in the non-HIV-positive population at relatively high CD4+ cell levels before cellular immunity grossly declines. The chronic cough as a possible symptom of tuberculosis infection was reported in high prevalence as well from patients in stage III of the disease irrespective of an established diagnosis or not. Tuberculosis and candidiasis are known as opportunistic diseases from HIV patients above all from those with weak immunity [15]. Indeed, tuberculosis testing for all HIV patients is an international policy and is part of the national HIV control programs. However, in the Republic of Congo there is no a systematic screening for TB in patients diagnosed with HIV. This lack of screening hinders the management and personalization of ART therapy, making it difficult to obtain optimal treatment outcomes. We reported that the BMI was significantly associated with age and educational level. A study conducted in USA on HIV-infected youth aged 10-19 [16] showed that HIV-infected Afro-American youth had significantly lower BMI scores compared to Afro-American national averages, indicating that growth and BMI can be impacted by HIV status in younger populations and age is a factor that can influence BMI changes. Accordingly, the normal BMI represented the optimal category for viral suppression, whereas patients with a lower BMI retained a twofold risk of maintaining a detectable viral load. A study [17] reported that HIV patients with normal BMI at baseline had better immune reconstitution and viral suppression outcomes after antiretroviral therapy (ART). Underweight patients (BMI \u0026lt;18.5) were at significantly higher risk of poor viral suppression and had a roughly 1.24 times higher adjusted hazard ratio to maintain detectable viral load compared to patients with normal BMI. It was demonstrated that HIV/AIDS patients receiving ART with higher baseline BMI had better immune reconstitution and that baseline BMI could be an important predictor of immune reconstitution in patients receiving ART [17].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe statistically significant association observed between matrimonial status and WHO clinical stage may reflect the role of social and family support in HIV management. Patients living in union (married or cohabiting) were more represented in advanced stages of the disease, which could suggest delayed diagnosis due to family responsibilities, social stigma, or underestimation of personal risk. Conversely, single patients, who predominated in early stages, may have benefited from earlier testing and linkage to care. Previous studies have shown that matrimonial status can influence adherence to treatment, disclosure of HIV status, and access to healthcare services, thereby impacting disease progression [18, 19]. This highlights the importance of integrating socio-behavioral factors, including family and community support, into HIV care and prevention strategies.\u003c/p\u003e\n\u003cp\u003eIn this study, included patients were mostly treated with the \u003cem\u003eDTG+3TC+TDF\u0026nbsp;\u003c/em\u003ecombination as first-line ART. This regimen has been demonstrated to be associated with rapid HIV RNA decline, durable viral suppression, and low rates of resistance [20]. This regimen is strongly recommended by WHO as the preferred first-line ART for adults and adolescents living with HIV [21]. As it is known that the number of doses and amount of pills per day is an important challenge for HIV patients, this regimen has to be taken only once daily, which can further support the treatment adherence for this population.\u003c/p\u003e\n\u003cp\u003eOur analysis further showed that treatment interruption was strongly associated with the maintenance of unsuppressed viral load. It has been shown that when patients discontinue therapy, the immediate consequence was the rapid decline of antiretroviral drug levels, allowing active viral replication to resume [22]. This uncontrolled replication contributes to viral rebound, which has multiple clinical and public health implications. First, it substantially increases the risk of opportunistic infections, as the immune system becomes progressively weakened. Second, elevated viral load during rebound enhances the probability of onward HIV transmission to sexual partners or through other routes of exposure. In addition to these immediate risks, treatment interruption also drives the selection of resistant viral strains. Because replication occurs in the presence of suboptimal or waning drug concentrations, resistant variants are more likely to emerge. This not only compromises the effectiveness of the current regimen but also limits the options available for future treatment, particularly in resource-limited settings where access to second or third-line therapies is restricted [23]. Taken together, these findings underscore the critical importance of sustained adherence to ART, both for individual clinical outcomes and for broader epidemic control. The only limitation that should be highlighted for this study; the aspect of CD4 counting has been not considered which can help to understand very well the relationship between the viral load suppression and weakness of the immune system of infected people.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, we found that patients who initiated ART therapy between five and ten years after testing HIV positive were more likely to have an unsuppressed viral load and to present with advanced clinical stages, compared to those who started treatment within five months. A variety of factors, including tuberculosis, candidiasis, treatment interruption, underweight and delaying antiretroviral treatment initiation were significantly associated with the disease severity. Regular monitoring of these factors will be essential for tracking HIV/AIDS status and improving patient management and clinical counseling. Future studies should include subjects with different ethnic backgrounds, and functional evaluation could be used to examine the relationship between predictive factors and the progression of HIV/AIDS.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e3TC: Lamivudine\u003c/p\u003e\n\u003cp\u003eAAP\u0026nbsp;: Association Avenir Positif\u003c/p\u003e\n\u003cp\u003eABC: Abacavir\u003c/p\u003e\n\u003cp\u003eAIDS\u0026nbsp;: Acquired Immunodeficiency Syndrome\u003c/p\u003e\n\u003cp\u003eAOR: Adjusted Odds Ratio\u003c/p\u003e\n\u003cp\u003eART\u0026nbsp;: Anti-Retroviral Therapy\u003c/p\u003e\n\u003cp\u003eAZT\u0026nbsp;: Zidovudine or Azidothymidine\u003c/p\u003e\n\u003cp\u003eBMI\u0026nbsp;: Body Mass Index\u003c/p\u003e\n\u003cp\u003eCeRMI-CM\u0026nbsp;: Centre de Recherche sur les Maladies Infectieuses Christophe M\u0026eacute;rieux\u003c/p\u003e\n\u003cp\u003eddI\u0026nbsp;: Didanosine\u003c/p\u003e\n\u003cp\u003eDRV\u0026nbsp;: Darunavir\u003c/p\u003e\n\u003cp\u003eDTG\u0026nbsp;: Dolutegravir\u003c/p\u003e\n\u003cp\u003eEDTA: Ethylene-Diamine-Tetra-Acetic\u003c/p\u003e\n\u003cp\u003eEFV: Efavirenz\u003c/p\u003e\n\u003cp\u003eFCRM\u0026nbsp;: Fondation Congolaise pour la Recherche M\u0026eacute;dicale\u003c/p\u003e\n\u003cp\u003eFTC\u0026nbsp;: Emtricitabine\u003c/p\u003e\n\u003cp\u003eHIV\u0026nbsp;: Human Immunodeficiency Virus\u003c/p\u003e\n\u003cp\u003eLPV/r: Lopinavir/Ritonavir\u003c/p\u003e\n\u003cp\u003eNVP\u0026nbsp;: Nevirapine\u003c/p\u003e\n\u003cp\u003eOR\u0026nbsp;: Odds Ration\u003c/p\u003e\n\u003cp\u003eRAL\u0026nbsp;: Raltegravir\u003c/p\u003e\n\u003cp\u003eRT-qPCR: Real Time quantitative Polymerase Chain Reaction\u003c/p\u003e\n\u003cp\u003eRTV : Ritonavir\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSD\u0026nbsp;: Standard Deviation\u003c/p\u003e\n\u003cp\u003eSTI: Sexually Transmitted Infections\u003c/p\u003e\n\u003cp\u003eTDF\u0026nbsp;: Tenofovir Disoproxil Fumarate\u003c/p\u003e\n\u003cp\u003eUNAIDS\u0026nbsp;: United Nation programme on HIV/AIDS\u003c/p\u003e\n\u003cp\u003eWHO : World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by grants from CANTAM (EDCTP-CSA2020NoE-3100). The funders had no role in the design, analysis, or decision to submit this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of author contribution\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFN supervised the overall work. FN, AMM, MPG and DM were involved in the study design. AMEI, CCMM,\u0026nbsp;LMM,\u0026nbsp;EPOM and FHM were involved in sample collection and analysis. Data analysis was performed by JCV and CCMM. All authors contributed to the manuscript. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of competing interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of AI use\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eArtificial intelligence (AI) tools, specifically ChatGPT and Perplexity developed by OpenAI, were used to search specific cited articles, summarize litterature and check grammar. All content was subsequently reviewed and edited by the authors to ensure accuracy and originality. The authors take full responsibility for the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the staff of the Centre Avenir Positif and all HIV patients and their families who participated in this study. We also thank Adrian J.F. Luty for help with manuscript preparation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Human Ethics and Consent to Participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was reviewed and approved by the institutional ethics committee of FCRM (n\u0026deg;034/CIE/FCRM/2021).\u0026nbsp;Written informed consent was obtained from each adult patient or from parents or legal guardians of all under 18 years old in addition to providing an assent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePatrias K, W.D., \u003cem\u003eHIV and Infections.\u003c/em\u003e Medline plus, 2007.\u003c/li\u003e\n\u003cli\u003eONUSIDA, \u003cem\u003eFiche d\u0026apos;information \u0026mdash; Derni\u0026egrave;res statistiques sur l\u0026apos;\u0026eacute;tat de l\u0026apos;\u0026eacute;pid\u0026eacute;mie de sida. Disponible en ligne: \u003c/em\u003e\u003cem\u003ehttps://www.unaids.org/fr/resources/fact-sheet\u003c/em\u003e\u003cem\u003e (consult\u0026eacute; le 17 janvier 2025).\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eWHO, \u003cem\u003eGlobal Action Plan on HIV Drug Resistance 2017-2021 Gen\u0026egrave;ve, WHO [en ligne] \u003c/em\u003e\u003cem\u003ehttp://apps.who.int/iris/bitstream/10665/255883/1/9789241512848-eng.pdf?ua=1\u003c/em\u003e\u003cem\u003e (page consult\u0026eacute;e le 19/01/2025).\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eMSF, \u003cem\u003eUntangling the web of antiretroviral price reduction 18th Edition-July 2016, rapport MSF, Gen\u0026egrave;ve [en ligne], \u003c/em\u003e\u003cem\u003ehttps://msfaccess.org/sites/default/files/HIV_report_Untangling-the-web-18thed_ENG_2016.pdf\u003c/em\u003e\u003cem\u003e (page consult\u0026eacute;e le 19/01/2025).\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eLuo, H., M. Sun, and J. Du, \u003cem\u003eAssociated factors for progression to AIDS among HIV-infected people who use drugs: a retrospective cohort study in Dongguan, China.\u003c/em\u003e BMJ Open, 2019. \u003cstrong\u003e9\u003c/strong\u003e(7): p. e023841.\u003c/li\u003e\n\u003cli\u003eUNAIDS, \u003cem\u003eCountry factsheets Congo, HIV and AIDS Estimates.\u003c/em\u003e Google, 2023.\u003c/li\u003e\n\u003cli\u003eUNAIDS, \u003cem\u003eCountry factsheets, Congo 2024\u003c/em\u003e, in \u003cem\u003eGoogle\u003c/em\u003e. 2025.\u003c/li\u003e\n\u003cli\u003epopulation, M.d.l.s.e.d.l., \u003cem\u003eMessage du gouvernement \u0026agrave; l\u0026rsquo;occasion de la c\u0026eacute;l\u0026eacute;bration de la 34e journ\u0026eacute;e mondiale de lutte contre le vih/sida.Le 1er d\u0026eacute;cembre 2022. Disponible en ligne: \u003c/em\u003e\u003cem\u003ehttps://sante.gouv.cg/message-du-gouvernement-2/\u003c/em\u003e\u003cem\u003e ( consult\u0026eacute; le 18 janvier 2025).\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eWHO, A.r., \u003cem\u003eCountry Disease Outlook, Congo.\u003c/em\u003e Google, 2023.\u003c/li\u003e\n\u003cli\u003eWiddowson, M.A., et al., \u003cem\u003eOutbreaks of acute gastroenteritis on cruise ships and on land: identification of a predominant circulating strain of norovirus--United States, 2002.\u003c/em\u003e J Infect Dis, 2004. \u003cstrong\u003e190\u003c/strong\u003e(1): p. 27-36.\u003c/li\u003e\n\u003cli\u003eMagadi, M.A., \u003cem\u003eUnderstanding the gender disparity in HIV infection across countries in sub-Saharan Africa: evidence from the Demographic and Health Surveys.\u003c/em\u003e Sociol Health Illn, 2011. \u003cstrong\u003e33\u003c/strong\u003e(4): p. 522-39.\u003c/li\u003e\n\u003cli\u003ehealthcare, G.V., \u003cem\u003eHIV IN WOMEN.\u003c/em\u003e Google, 2023.\u003c/li\u003e\n\u003cli\u003eRosenberg, N.E., \u003cem\u003eHIV testing to the test: does HIV testing promote HIV prevention in HIV-uninfected adults?\u003c/em\u003e Sex Transm Infect, 2016. \u003cstrong\u003e92\u003c/strong\u003e(8): p. 566-567.\u003c/li\u003e\n\u003cli\u003eRosenberg, N.E., et al., \u003cem\u003eThe effect of HIV counselling and testing on HIV acquisition in sub-Saharan Africa: a systematic review.\u003c/em\u003e Sex Transm Infect, 2016. \u003cstrong\u003e92\u003c/strong\u003e(8): p. 579-586.\u003c/li\u003e\n\u003cli\u003eRiccardi, N., G.A. Rotulo, and E. Castagnola, \u003cem\u003eDefinition of Opportunistic Infections in Immunocompromised Children on the Basis of Etiologies and Clinical Features: A Summary for Practical Purposes.\u003c/em\u003e Curr Pediatr Rev, 2019. \u003cstrong\u003e15\u003c/strong\u003e(4): p. 197-206.\u003c/li\u003e\n\u003cli\u003eArbeitman, L.E., et al., \u003cem\u003eBody mass index and waist circumference of HIV-infected youth in a Miami cohort: comparison to local and national cohorts.\u003c/em\u003e J Pediatr Gastroenterol Nutr, 2014. \u003cstrong\u003e59\u003c/strong\u003e(4): p. 449-54.\u003c/li\u003e\n\u003cli\u003eZhu, J., et al., \u003cem\u003eHigh baseline body mass index predicts recovery of CD4+ T lymphocytes for HIV/AIDS patients receiving long-term antiviral therapy.\u003c/em\u003e PLoS One, 2022. \u003cstrong\u003e17\u003c/strong\u003e(12): p. e0279731.\u003c/li\u003e\n\u003cli\u003eMirzaei-Alavijeh, M., et al., \u003cem\u003eInsights into medication adherence among HIV-positive patients: the integrated change model.\u003c/em\u003e AIDS Res Ther, 2025. \u003cstrong\u003e22\u003c/strong\u003e(1): p. 66.\u003c/li\u003e\n\u003cli\u003eGutin, S.A., et al., \u003cem\u003eSupportive couple relationships buffer against the harms of HIV stigma on HIV treatment adherence.\u003c/em\u003e BMC Public Health, 2023. \u003cstrong\u003e23\u003c/strong\u003e(1): p. 1878.\u003c/li\u003e\n\u003cli\u003eNye, J., \u003cem\u003eFirst-line ART regimen DTG/3TC efficacious in adults with high HIV viral load.\u003c/em\u003e HIV and Co-Infections News, 2025.\u003c/li\u003e\n\u003cli\u003e, W.H.O., \u003cem\u003eUPDATE ON THE TRANSITION TO DOLUTEGRAVIR-BASED ANTIRETROVIRAL THERAPY: REPORT OFA WHO MEETING\u003c/em\u003e. 2022.\u003c/li\u003e\n\u003cli\u003eGuy, R., et al., \u003cem\u003eAntiretroviral treatment interruption and loss to follow-up in two HIV cohorts in Australia and Asia: implications for \u0026apos;test and treat\u0026apos; prevention strategy.\u003c/em\u003e AIDS Patient Care STDS, 2013. \u003cstrong\u003e27\u003c/strong\u003e(12): p. 681-91.\u003c/li\u003e\n\u003cli\u003eUNAIDS, \u003cem\u003eQ\u0026amp;A on the impact of the interruption of treatment for people living with HIV\u003c/em\u003e. 2025.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 5 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"HIV/AIDS, associated factors, clinical stages, Pointe-Noire, Republic of Congo","lastPublishedDoi":"10.21203/rs.3.rs-7622263/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7622263/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e\u003cp\u003eHIV infection continues to be a major contributor to morbidity and mortality in develpping countries, including the Republic of the Congo. The progression of the infection to advanced stages is influenced by various factors such as viral genetics, host immune responses variation, body mass index (BMI), treatment interruption or lack of treatment access. This study describes the characteristics of HIV patients on ART and identifies factors associated with viral load suppression in a Congolese urban population.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis cross-sectional study was conducted from June to July 2021 in Pointe Noire. Patients were recruited at the \u0026lsquo;Centre Avenir Positif\u0026rsquo;. Following a clinical evaluation by a healthcare provider, socio-behavioral, sociodemographic, and clinical data were extracted from patients updated medical records, in addition 5 mL of individual blood was sampled for viral load measurement, using Xpert\u0026reg;-HIV-1 Viral Load assay.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 510 known HIV positive patients were included in this study. Most of them were women 311 (61%). The analysis revealed a positive association (p\u0026thinsp;=\u0026thinsp;0.022) between age groups and HIV disease stage, with stage II more prevalent in younger patients (1\u0026ndash;17 years) and stage III more common in adults (18\u0026ndash;50 years). Tuberculosis (15.6% at Stage I, 36.44% at Stage II, and 51.7% at Stage III) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and candidiasis (p\u0026thinsp;=\u0026thinsp;0.023) were two opportunistic infections significantly associated with the advanced stages of the disease. In addition, a significantly association was found between treatment interruption (11.6%) and the advanced phase of the disease (Stage III, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Body mass index was statistically significantly associated with advanced stage of the disease: the proportion of cases with elevated BMI was high in Stage III (58.6%; p\u0026thinsp;=\u0026thinsp;0.041). Finally, patients who delayed initiating antiretroviral treatment more than five years after being tested HIV positive were 2.33 times more likely to have an unsuppressed viral load ( p\u0026thinsp;=\u0026thinsp;0.073).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eFactors such as tuberculosis, candidiasis, treatment interruption, underweight and delaying antiretroviral treatment initiation were significantly associated with the disease severity. Regular monitoring of these factors is essential for tracking HIV/AIDS status and improving patient management and clinical counseling.\u003c/p\u003e","manuscriptTitle":"Epidemiological characteristics of people living with HIV on antiretroviral therapy (ART) in Pointe-Noire, Republic of Congo","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 09:52:57","doi":"10.21203/rs.3.rs-7622263/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-28T06:50:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-27T17:17:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-24T11:32:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"203863353639067601465483506757475344629","date":"2025-10-19T09:33:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"195640996758242265064275422530558937431","date":"2025-10-15T15:09:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"34801702091811530180810402187429497461","date":"2025-10-07T12:38:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-25T15:29:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-25T14:39:30+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-23T06:51:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-21T21:31:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-09-21T21:28:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e5072edd-fb3d-4391-8bca-cb03be9a1b33","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:07:11+00:00","versionOfRecord":{"articleIdentity":"rs-7622263","link":"https://doi.org/10.1186/s12879-025-12178-6","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2026-01-08 15:59:30","publishedOnDateReadable":"January 8th, 2026"},"versionCreatedAt":"2025-10-08 09:52:57","video":"","vorDoi":"10.1186/s12879-025-12178-6","vorDoiUrl":"https://doi.org/10.1186/s12879-025-12178-6","workflowStages":[]},"version":"v1","identity":"rs-7622263","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7622263","identity":"rs-7622263","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}