Abstract
BACKGROUND: Detectable viral load (DVL) after ≥ 6 months of antiretroviral therapy (ART) and underweight are common among adolescents with HIV (AWH) but remain understudied. We assessed the association between underweight at ART initiation and DVL among AWH in rural eastern Uganda. METHODS: We retrospectively reviewed program data for AWH aged 10-19 years from 11 clinics in eight districts. Underweight was defined as body mass index (BMI) for age <5th percentile at ART initiation. DVL was defined as the first viral load ≥ 1,000 copies/mL after ≥ 6 months on ART. Associations were examined using multi-level mixed-effects Poisson regression, adjusting for individual-level factors and accounting for clustering by district and health facility. RESULTS: We analyzed 525 AWH, of whom 47.6% were aged 10-14 years and 51.0% were male. At ART initiation, 79.2% were underweight, and 19.0% had DVL after ≥ 6 months on ART. In multivariable analysis, underweight at ART initiation was significantly associated with DVL (adjusted risk ratio [aRR] 1.66, 95% confidence interval [CI] 1.07-2.56). DVL was also associated with baseline CD4 count ≤ 200 cells/µL (aRR 1.36, 95% CI 1.12-1.66), and there was no statistically significant association with interruption in ART (aRR 1.43, 95% CI 0.89-2.29). CONCLUSION: Among AWH in rural eastern Uganda, the prevalence of DVL was nearly four times the UNAIDS target of ≤ 5%. DVL was linked to underweight and severe immunodeficiency. Interventions such as nutritional support, targeted adherence counseling, early HIV diagnosis, and prompt ART initiation are critical to achieving viral suppression in this setting.