Review Article

Low-level viraemia: An emerging concern among people living with HIV in Uganda and across sub-Saharan Africa

Nicholus Nanyeenya, Noah Kiwanuka, Damalie Nakanjako, Gertrude Nakigozi, Simon P.S. Kibira, Susan Nabadda, Charles Kiyaga, Isaac Sewanyana, Esther Nasuuna, Fredrick Makumbi
African Journal of Laboratory Medicine | Vol 11, No 1 | a1899 | DOI: https://doi.org/10.4102/ajlm.v11i1.1899 | © 2022 Nicholus Nanyeenya, Noah Kiwanuka, Damalie Nakanjako, Gertrude Nakigozi, Simon P.S. Kibira, Susan Nabadda, Charles Kiyaga, Isaac Sewanyana, Esther Nasuuna, Fredrick Makumbi | This work is licensed under CC Attribution 4.0
Submitted: 23 March 2022 | Published: 20 October 2022

About the author(s)

Nicholus Nanyeenya, Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; and, Ministry of Health Central Public Health Laboratories, Kampala, Uganda
Noah Kiwanuka, Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
Damalie Nakanjako, Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
Gertrude Nakigozi, Rakai Health Sciences Project, Masaka, Uganda
Simon P.S. Kibira, Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
Susan Nabadda, Ministry of Health Central Public Health Laboratories, Kampala, Uganda
Charles Kiyaga, Ministry of Health Central Public Health Laboratories, Kampala, Uganda
Isaac Sewanyana, Ministry of Health Central Public Health Laboratories, Kampala, Uganda
Esther Nasuuna, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
Fredrick Makumbi, Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda


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Abstract

Attaining viral load (VL) suppression for over 95% of the people living with HIV on antiretroviral therapy is a fundamental step in enabling Uganda and other sub-Saharan African countries to achieve global Sustainable Development Goal targets to end the HIV/AIDS epidemic by 2030. In line with the 2013 World Health Organization recommendations, several sub-Saharan African countries, including Uganda, use a threshold of 1000 HIV viral RNA copies/mL to determine HIV viral non-suppression. The United States Centers for Disease Control and Prevention and the International Association of Providers of AIDS Care deem this threshold very high, and hence recommend using 200 copies/mL to determine viral non-suppression. Using 1000 copies/mL as a threshold ignores people living with HIV who have low-level viraemia (LLV; HIV VL of at least 50 copies/mL but less than 1000 copies/mL). Despite the 2021 World Health Organization recommendations of using intensive adherence counselling for people living with HIV with LLV, several sub-Saharan African countries have no interventions to address LLV. However, recent studies have associated LLV with increased risks of HIV drug resistance, virologic failure and transmission. The purpose of this narrative review is to provide insights on the emerging concern of LLV among people living with HIV receiving antiretroviral therapy in sub-Saharan Africa. The review also provides guidance for Uganda and other sub-Saharan African countries to implement immediate appropriate interventions like intensive adherence counselling, reducing VL thresholds for non-suppression and conducting more research to manage LLV which threatens progress towards ending HIV by 2030.


Keywords

HIV/AIDS; low-level viraemia; viral load testing; non-suppression; virologic failure

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