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European Journal of Applied Sciences – Vol. 10, No. 3
Publication Date: June 25, 2022
DOI:10.14738/aivp.103.12177. Babatope, I. O., Esumeh, F. I., Orhue, P. I., & Iyevhobu, K. O. (2022). Viral Load Pattern and Virological Suppression Rate of a Cohort
of Hiv-1 Patients in a Rural Community in Nigeria. European Journal of Applied Sciences, 10(3). 8-19.
Services for Science and Education – United Kingdom
Viral Load Pattern and Virological Suppression Rate of a Cohort
of Hiv-1 Patients in a Rural Community in Nigeria
Babatope, I. O.
Department of Medical Laboratory Science
Faculty of Basic Medical Sciences
Ambrose Alli University, Ekpoma, Edo State
Nigeria and Department of Haematology
Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
Esumeh, F. I.
Department of Microbiology, Faculty of Life Sciences
Ambrose Alli University, Ekpoma, Edo State, Nigeria
Orhue, P. I.
Department of Medical Laboratory Science
Faculty of Basic Medical Sciences
Ambrose Alli University, Ekpoma, Edo State
Nigeria and Department of Haematology
Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
Iyevhobu, K. O.
Department of Public Health, National Open University of Nigeria
Uromi Community Study Centre, Uromi, Edo State, Nigeria
ABSTRACT
HIV is a pandemic infection and remains a public health concern for many decades.
This infection is associated with life threatening depletion of immune response,
opportunistic infections and malignancies. The aim of this study is to determine the
viral load pattern and virological suppression rate of HIV-1 subjects in Irrua, Edo
Central Senatorial District of Edo state, Nigeria. A total of three hundred and forty
four (344) HIV-1 subjects aged between 17-60 years and of both sexes were
recruited into the study. The HIV-1 subjects were divided into asymptomatic and
symptomatic subjects. One hundred and fifty (150) apparently healthy HIV-1
negative subjects served as control. The viral load titre was determined using the
COBAS Ampliprep/COBAS “Taqman” HIV-RNA test (PCR technology). Results
obtained revealed that the mean viral loads of the asymptomatic and symptomatic
HIV-1 subjects were 20,333.00±13,474.65 and 535,000.02±485,423.40 against
control (20.00±0.00). Both asymptomatic and symptomatic groups revealed a
statistical significant difference (P<0.05). Furthermore, there was no significant
difference according to gender while comparison between viral load and age
showed a statistically significant difference (P<0.05).The overall virological
suppression rate of HIV-1 subjects on-ART was 81.6%. Sex-wise distribution
revealed that more females (48.87%) were virally suppressed compared to their
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Babatope, I. O., Esumeh, F. I., Orhue, P. I., & Iyevhobu, K. O. (2022). Viral Load Pattern and Virological Suppression Rate of a Cohort of Hiv-1 Patients
in a Rural Community in Nigeria. European Journal of Applied Sciences, 10(3). 8-19.
URL: http://dx.doi.org/10.14738/aivp.103.12177
male counterparts (32.73%). According to age distribution, subjects belonging to
the age bracket of 37-46 years recorded the highest frequency distribution of
37.96% while the least (5.70%) belonged to the age group of 17-26 years. In
summary, there was a significant and progressive increase in the viral load titre of
asymptomatic and symptomatic HIV-1subjects in relation to control. Also, the
proportion of HIV-1 subjects who had viral load <1,000 RNA copies/ml was
relatively high at 81.6% but falls short of UNAIDS’ 90% target for on-treatment viral
suppression. It re-emphasizes the need to test subjects and start treatment with
antiretroviral drugs early.
Keywords: Viral load, Virological suppression rate, HIV-1 subjects, Irrua
INTRODUCTION
At the 2014 International AIDS Conference in Melbourne, the Joint United Nations Programme
on HIV/AIDS (UNAIDS) proposed the 90-90-90 and 95-95-95 targets to accelerate efforts
towards ending the epidemic by 2030, which was approved by the United Nations (UN)
(UNAIDS, 2014; United Nations General Assembly (UNGA), 2016).
The UNAIDS 90-90-90 declaration states that by 2020, 90 percent of people living with HIV
should know their status, 90 percent of people who know their status should be sustained on
combination ART, and 90 percent of treated patients should achieve viral suppression (UNAIDS
2015; UNAIDS, 2017a). Viral load suppression is an important component of the UNAIDS 90-
90-90 declaration (UNAIDS, 2015). HIV-1 viral load (VL) is an important clinical endpoint
(Quinn et al., 2000; Attia et al., 2009). Viral load suppression reduces onward transmission and
improves the long-term health and quality of life of people living with HIV (UNAIDS, 2017b).
Sub-Saharan Africa (divided now in UNAIDS reports into Eastern/Southern Africa and
Western/Central African) continues to bear the brunt of this epidemic with 25.5 million adults
and children (69% of global total) living with HIV in 2015 (UNAIDS, 2016). Nigeria has the
second largest HIV epidemic in the world (NACA, 2017). Although HIV prevalence among adults
is much less (1.5%) than other sub-Saharan African countries such as South Africa (20.4%) and
Zambia (11.3%), the size of Nigeria’s population means that 1.9 million people were living with
HIV in 2018 (NAIIS, 2018). Although Nigeria adopted the “test and treat” policy of WHO in 2015
which means anyone with a positive diagnosis is eligible for treatment, this is far from reality.
This is because at the national level, viral suppression (the last 90) among people living with
HIV aged 15-49 years stand at 42.3% (45.3% among women and 34.5% among men) (NAIIS,
2018). In view of the above-mentioned, it is essential to look at the viral load pattern and viral
suppression rate of HIV-1 subjects in Edo Central Senatorial district of Edo State, Nigeria with
emphasis on determining its last 90 status.
MATERIALS & MATERIALS
A total of three hundred and forty four (344) HIV-1 subjects which comprised two hundred
(200) asymptomatic HIV-1 subjects not-on-ART (Group 1) and one hundred and forty four
(144) symptomatic HIV-1 subjects (On-ART) (group 2) were recruited for this study. One
hundred and fifty (150) apparently healthy HIV-1 negative individuals served as the control
group (group 3). The subjects were between 17 and 60 years of age and of both sexes.
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European Journal of Applied Sciences (EJAS) Vol. 10, Issue 3, June-2022
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Subjects and selection criteria
The subjects were grouped into asymptomatic HIV-1 subjects, symptomatic HIV-1 subjects and
apparently healthy HIV-1 negative subjects. Selection criteria included inclusion and exclusion
criteria and clinical stage of the subjects based on WHO clinical staging of HIV/AIDS and case
definition for resource-constrained settings. All the subjects were recruited voluntarily through
the HIV counseling and Testing services (HCT) unit and the Adult Retroviral Clinic of Irrua
Specialist Teaching Hospital, Irrua, Edo State.
Ethical Approval
Approval was obtained from the Ethics and Research Committee of Irrua Specialist Teaching
Hospital (I.S.T.H.), Irrua, Edo State, Nigeria for this study. Informed consent was obtained from
each participant/subject before blood collection.
Blood sampling and handling
Ten millitres (10ml) of whole blood was withdrawn by venipuncture from the antecubital vein
using vacutainer needles into two EDTA containers. The two EDTA containers were spun at
800-1,600 x g for 20 minutes at room temperature. About 1.2ml each of the plasma was
transferred into three (3) sterile polypropylene screw capped (cryovials) tubes. All viral load
samples were stored at between - 200C and -700C prior to analysis.
Viral load estimation
The COBAS (R) Ampliprep/COBAS® Taqman® (COBAS Amplicor; Roche Diagnostics, Rotkrous,
Switzerland) was used. The HIV-1 test is an in vitro nucleic acid amplification test for the
quantification of Human Immunodeficiency Virus type 1 (HIV-1) RNA in human plasma using
COBAS® AmpliPrep/instrument for automated specimen amplification and detection. The
principle is based on real-time technologies that continuously monitor the fluorescence emitted
by the amplification products. The test can quantitate HIV-1 RNA over the range of 48-
10,000,000 copies/mL. One copy of HIV-1 RNA is equivalent to 1.7 ± 1.0 International Units (IU)
based on WHO 1st International Standard for HIV-1 RNA for Nucleic Acid Based Techniques
(NAT).
Viral load suppression rate
Viral load suppression rate was determined at 90% suppressed viral load which equivalent to
90% Suppressed viral load =
Number of patients on antiretroviral therapy with suppressed viral load
The number of patients taking antiretroviral therapy
Statistical analysis
The data generated from this study was analyzed by Student’s t-test and analysis of variance
(ANOVA). Values with P<0.05 was considered statistically significant.
RESULTS
Viral load of the study population
The results of the viral load of the study population are presented in Table 1. The mean ± SD
values of control, asymptomatic and symptomatic subjects were 20.00±0.00,
20,333.00±13,474.65and 535,000.02±485,423.43 respectively. There was a significant
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Babatope, I. O., Esumeh, F. I., Orhue, P. I., & Iyevhobu, K. O. (2022). Viral Load Pattern and Virological Suppression Rate of a Cohort of Hiv-1 Patients
in a Rural Community in Nigeria. European Journal of Applied Sciences, 10(3). 8-19.
URL: http://dx.doi.org/10.14738/aivp.103.12177
increase (P<0.05) in the mean value of the viral load of symptomatic subjects in comparison to
asymptomatic subjects and control.
Viral load of symptomatic HIV-1 subjects on-ART and not on-ART
The mean viral load of symptomatic subjects on-ART and not-on-ART were 37,251.00 ±
9,735.33 and 455,578.00 ± 41,878.79 respectively (Table 2). Statistical comparison revealed a
statistical significant difference (P<0.05) between the two groups.
Viral load of asymptomatic HIV-1 subjects based on gender
The results of the viral load of asymptomatic subjects based on gender are highlighted in Table
3. The mean values of the viral load of both male and female asymptomatic subjects were
26,372.00±14,629.15 and 16,139.00±10,970.98 respectively. There was a significant increase
(P<0.05) between the viral load of asymptomatic male subjects compared to their female
counterparts.
Viral load of symptomatic HIV-1 subjects based on gender
The mean values of the viral load of symptomatic HIV-1 subjects based on gender are presented
in Table 4. The mean values of the viral load of the male and female subjects were
407,402.00±301,914.30 and 617,805.00±562,662.50 respectively. There was no significant
difference (P>0.05) between the viral load based on gender.
Viral load of asymptomatic HIV-1 subjects based on age
The results of the viral load of asymptomatic HIV-1 subjects based on age are presented in Table
5. The mean values of the viral load of the subjects belonging to age groups of 17-26 years, 27-
36 years, 37-46 years and 47 years and above were 1,850.00±602,77, 8,328.00±5,983.39,
23,700.00±6,863.95 and 41,333.00±9,000.00 respectively. There was no significant difference
(P>0.05) in the mean values of the viral load of asymptomatic subjects belonging to the age
groups of 17-26 years and 27-36 years, whereas subjects belonging to the age groups of 37-46
years and 47 years and above revealed statistically significant increase (P<0.05).
Viral load of symptomatic HIV-1 subjects based on age
The mean values of the viral load of symptomatic HIV-1 subjects based on age are presented in
Table 6. The mean ± SD of the viral load of the subjects according to the age groups of 17-26
years, 27-36 years, 37-46 years and 47 years and above were 430,838.00 ± 416,138.40,
367,139.00 ± 312,930.60, 461,435.00 ± 427,637.50 and 1,202,110.00 ± 513,253.80
respectively. Subjects belonging to the age groups of 17-26 years, 27-36 years and 37-46 years
did not reveal any significant difference (P>0.05) in the mean values of the viral load of
symptomatic HIV-1 subjects ,whereas the subjects belonging to age groups of 47 years and
above showed a statistically significant increase (P<0.05).
Age and sex distribution of symptomatic HIV-1 subjects on-ART
The age and sex distribution of symptomatic HIV-1 subjects on-ART in the study area are
presented in Table 7. According to age groups, subjects belonging to the age bracket 37-46
years recorded the highest frequency distribution followed by those in the age bracket of 27-
36 years with subjects belonging to the age group of 17-26 years ranked as the least. According
to sex, more female subjects (60.0%) are on-ART compared to their male counterparts (40.0%).
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European Journal of Applied Sciences (EJAS) Vol. 10, Issue 3, June-2022
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Viral load suppression rate of symptomatic HIV-1 subjects on-ART
The results of the viral load suppression rate of symptomatic HIV-1 subjects on-ART in the
study area are presented in Table 8. According to age and sex, subjects belonging to the age
bracket of 37-46 years recorded the highest frequency of viral load suppression for both male
and female sexes followed by those in the age group of 27-36years with the least belonging to
the age group of 17-26 years. More women (48.87%) had viral load suppression compared to
their male counterparts (32.73%). The overall viral load suppression rate of symptomatic HIV- 1 subject of-ART was 81.6% while 18.4% were virally unsuppressed.
Combined viral load suppression rate of symptomatic HIV-1 subjects on-ART
The combined viral load suppression rate of symptomatic HIV-1 subjects on–ART are presented
in Table 9. Subjects belonging to the age bracket of 37-46 years were the most virally
suppressed (37.96%) individuals followed by those in the age group of 27-36 years (27.03%).
Subjects belonging to the age group of 47 years and above had 10.9% with individuals
belonging to the age bracket of 17-26 years recording the least frequency distribution of 5.70%.
Table 1: Viral load of the study population
Parameter
Control
subjects
Mean ± SD
n = 150
Asymptomatic subjects
Mean ± SD
n = 200
Symptomatic Subjects
Mean ± SD
n = 144
F- value
P- value
Viral Load 20.00 ± 0.00a 20,333.00 ± 13,474.65b 535,000.02 ± 485,423.40c 7.390 0.0001
KEYS: n - Number of Samples
SD - Standard deviation
Values in a row with a different superscript is significantly different at P<0.05
Table 2: Viral load of symptomatic HIV-1 subjects on-ART and not-on--ART
Parameter Symptomatic
subjects
(On-ART)
Mean ± SD
n = 60
Symptomatic subjects
(Not-on-ART)
Mean ± SD
n = 84
T- value
P- value
Viral load
37,251.00 ± 9,735.33 455,578.00 ± 41,878.79 5.7699 0.0001
KEYS:
n - Number of Samples
SD - Standard deviation
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Babatope, I. O., Esumeh, F. I., Orhue, P. I., & Iyevhobu, K. O. (2022). Viral Load Pattern and Virological Suppression Rate of a Cohort of Hiv-1 Patients
in a Rural Community in Nigeria. European Journal of Applied Sciences, 10(3). 8-19.
URL: http://dx.doi.org/10.14738/aivp.103.12177
Table 3: Viral load of asymptomatic HIV-1 subjects based on gender
Parameter
Male subjects
Mean ± SD
n = 80
Female subjects
Mean ± SD
n = 120
F- value
P- value
Viral Load 26,372.00 ± 14,629.15 16,139.00 ± 10,970.98 3.1225 0.0028
KEYS:
n - Number of Samples
SD - Standard deviation
Table 4: Viral load of symptomatic HIV-1 subjects based on gender
Parameter
Male subjects
Mean ± SD
n = 58
Female subjects
Mean ± SD
n = 86
F- value
P- value
Viral Load 407,402.00±301,914.30 617,805.00±562,662.50 1.679 0.0985
KEYS:
n - Sample size
SD - Standard deviation
Table 5: Viral load of asymptomatic HIV-1 subjects based on age
Parameter
17-26yrs
Mean ± SD
n = 14
27-36yrs
Mean ± SD
n = 60
37 – 46yrs
Mean ± SD
n = 100
47yrs & above
Mean ± SD
n = 26
F- value
P- value
Viral load
1,850.00
±
602.77a
8,328.00
±
5,983.39a
23,700.00
±
6,863.94b
41,333.00
±
9,000.00b
315.45 0.0002
KEYS:
n - Sample size
SD - Standard deviation
Values in a row with a different superscript is significantly different at P<0.05
Table 6: Viral load of symptomatic HIV-1 subjects based on age
Parameter
17-26yrs
Mean ± SD
n = 10
27-36yrs
Mean ± SD
n = 54
37 – 46yrs
Mean ± SD
n = 60
47yrs & above
Mean ± SD
n = 20
F- valu
e
P- value
Viral load
430,838.00
±
416,138.40a
367,139.00
±
312,939.60a
461,345.00
±
427,637.50a
1,202,110.00
±
513,253.80b
4.96
14 0.0002
KEYS:
n - Sample size
P<0.05- Significant
P>0.05- Not Significant
Values in a row with a different superscript is significantly different at P<0.05
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European Journal of Applied Sciences (EJAS) Vol. 10, Issue 3, June-2022
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Table 7: Age and sex distribution of symptomatic HIV-1 subjects on-ART
Sex / Age groups Male Female
17-26 years 2 (3.33%) 2 (3.33%)
27-36 years 8 (13.33%) 12 (20.0%)
37-46 years 11 (18.33%) 17 (28.33%)
47 years and above 3 (5.0%) 5 (8.33%)
Total / Frequency 24 (40.0%) 36 (60.0%)
Table 8: Viral load suppression rate of symptomatic HIV-1 subjects on – ART
Viral load suppressed Viral load unsuppressed
Sex / Age groups Male Female Male Female
17-26years 1.43 1.99 0.32 0.45
27-36years 6.54 9.68 1.48 2.18
37-46years 9.11 13.67 2.05 3.08
46 years and above 2.56 3.98 0.58 0.9
Total/frequency 19.64 (32.73%) 29.32 (48.87%) 4.43 (7.38%) 6.61 (11.02%)
Overall frequency 81.6% 18.4%
Table 9: Combined viral load suppression rate of symptomatic HIV-1 subjects on-ART
Sex/Age group Male Female Combined frequency
17-26 years 1.43 (2.38%) 1.99 (3.32%) 5.70%
27-36 years 6.54 (10.9%) 9.68 (16.13%) 27.03%
37-46 years 9.11 (15.18%) 13.67 (22.78%) 37.96%
47 years and above 2.56 (4.27%) 3.98 (6.63%) 10.9%
19.64 (32.73%) 29.32 (48.86%) 81.59%
DISCUSSION
HIV-1 viral load is an important clinical endpoint ( Quinn et al.,2009).In this study, the mean
values of the viral load titre of asymptomatic and symptomatic HIV-1 subjects were
20,333.00±13,474.65 and 535,000.02±485,423.40 copies/ml respectively (table 1). Statistical
analysis revealed that there was a significant and progressive increase (P<0.05) in the viral load
titres of asymptomatic and symptomatic HIV-1 subjects in relation to control. This finding is in
line with the earlier reports of Piatak et al. (1993) and Cao et al.(1995) who observed that
subsequent improvements in the methods for detecting HIV have indicated that even
asymptomatic patients can carry 103-105 copies of HIV RNA per ml of plasma and symptomatic
patients can carry 105-108 copies/ml. Ochieng et al., (2006) reported that asymptomatic and
symptomatic HIV-1 disease had, respectively, a rise in median HIV-1 RNA load from 1,195 to
132,543 and from 42,962 to 1,109,281 copies/ml in children below 6 years. In a study,
Govender et al. (2014) reported an overall viral load of 13,000 (IQR: 2050 - 98171) copies/ml
among newly diagnosed HIV-infected individuals. In a very recent study, Kamangu, Bongenya,
Bulanda, Kalume, Mabanza & Kalala (2018) reported the median value of the viral load of their
patients to be 5.531 log10 RNA copies/ml (340,000 RNA copies/ml). The minimum and
maximum values were respectively 1.35-7.95 log10 RNA copies (22.28-88,850,000 RNA
copies/ml). Also, Kamangu et al. (2018) observed the minimum and maximum values were