Prevalence and determinants of virological non-suppression at 24 weeks among people living with HIV in Hubei, China

Virological non-suppression at 24 weeks after antiretroviral therapy (ART) initiation suggests a suboptimal early virological response and may help identify patients who require closer monitoring and support. However, real-world evidence on virological non-suppression at 24 weeks and its associated factors among treatment-naive people living with HIV (PLWH) in China remains limited. We conducted a retrospective cohort study using the HIV electronic database of the Hubei Provincial Center for Disease Control and Prevention. Treatment‑naive PLWH who initiated ART between Feb 2022 and Jun 2025 were included. The primary outcome was virological non-suppression at 24 weeks, defined as plasma HIV RNA > 200 copies/mL at the week 24 for HIV viral load (VL) assessment. Logistic regression was used to identify baseline demographic, clinical, and initial treatment factors associated with this outcome. Among 4535 treatment‑naive PLWH, the overall rate of virological non-suppression at 24 weeks during 2022–2025 was 6.81%. In multivariable analysis, female (aOR = 0.65, 95% CI: 0.46–0.93, p = 0.017), higher baseline CD4 count (200–349 vs. < 200: aOR = 0.57, 95% CI: 0.41–0.79, p < 0.001; 350–499 vs. < 200: aOR = 0.54, 95% CI: 0.35–0.85, p = 0.007), and initiation on integrase strand transfer inhibitor (INSTI)‑based regimens (aOR = 0.35, 95% CI: 0.26–0.48, p < 0.001) were associated with lower 24-week virological non-suppression rates. Higher baseline HIV VL (aOR = 1.83, 95% CI:1.57–2.13, p < 0.001) and infection via illicit drug use (aOR = 9.88, 95% CI:2.90–33.60, p < 0.001) were associated with higher 24-week virological non-suppression rate. These findings support early identification of treatment-naive PLWH at higher risk of 24-week virological non-suppression, particularly those with higher baseline VL, lower baseline CD4 count, infection via illicit drug use, and NNRTI-based initial regimens. Closer early VL monitoring and adherence support may help improve early virological response, while regimen optimization should be considered when clinically appropriate and accessible.