Long-term suppression of HIV in LMICs

Viral suppression is the cornerstone of success in long-term HIV treatment. The World Health Organization commissioned us to systematically review the scientific literature on HIV treatment outcomes. We focused on the viral loads of adults on first-line antiretroviral therapy for HIV-1 in low- and middle-income countries (LMICs). In addition, we included in the meta-analysis original, unpublished data from two large observational cohorts: PASER-M and TREAT Asia.


Our findings indicate favourable long-term virological outcomes for up to five years among people living with HIV on first-line antiretroviral therapy in low- and middle-income countries. More than 80% of people were virally suppressed after 5 years of first-line antiretroviral treatment. This proportion was stable but declined over time after correction for loss to follow-up. This review based on 184 cohorts provides the largest global overview of virological outcomes to date.


Our results can guide antiretroviral therapy program managers and policy makers on the levels of population-level viral suppression achieved elsewhere, against which they can evaluate their progress. Viral suppression is key to individual health, to reducing onward HIV transmission, and to curbing the emerging epidemic of HIV drug resistance.


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