Factors Associated With Viral Suppression Among People Living With HIV (PLWH) in Kermanshah, Iran: A Retrospective Cohort Study

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ABSTRACT Background and Aims Despite the expanded availability of antiretroviral therapy (ART), HIV remains a major global health challenge. Viral load (VL) is the main indicator used to assess treatment response, and viral suppression is the ultimate goal of therapy. However, virological response is influenced by various patient‐ and treatment‐related factors. This study aimed to identify factors associated with viral suppression among PLWH in Kermanshah, Iran. Methods We included 2909 PLWH attending the Kermanshah Behavioral Diseases Counseling Center between 2012 and 2023. Data on demographic, behavioral, and clinical characteristics, route of transmission, disease stage, clinic visits, CD4 counts, and VL were extracted from records. Due to the non‐normal distribution of VL, nonparametric tests (Spearman's correlation, Mann–Whitney U ‐test, and Kruskal–Wallis) were used. Analyses were performed in SPSS v21, with p < 0.05 considered significant. Results Among the 710 PLWH included in the analysis, 643 (90.6%) had viral suppression at the last available follow‐up VL measurement (VL < 200 copies/mL). In univariate analyses, sex, incarceration history, addiction history, injection drug use, marital status, occupation, clinical stage, route of HIV transmission, CD4 count, and duration of ART were significantly associated with viral suppression. In the multivariable logistic regression model, marital status, clinical stage, baseline CD4 count, and follow‐up CD4 count remained significantly associated with viral suppression after adjustment for the variables included in the model. Conclusion Most PLWH had viral suppression at the last follow‐up assessment. Disease stage, marital status, and follow‐up CD4 count were associated with viral suppression. These findings should be interpreted with caution because residual confounding cannot be excluded. Overall, the results highlight the importance of early HIV diagnosis, timely initiation of treatment, and sustained engagement in care to achieve optimal viral suppression.