Advancing HIV Treatment and Health Outcomes: Insights from Comprehensive Cohort Studies on Viral Suppression, Treatment Response, Immune Recovery, Metabolic and Long-Term Complications among People Living with HIV

This thesis presents a comprehensive investigation into various aspects of HIV treatment and health outcomes, providing insights on key factors that influence viral suppression, treatment response, immune recovery, metabolic factors, and long-term complications. The thesis includes studies encompassing diverse populations across different geographic regions, providing valuable insights into the global landscape of HIV care and studies that focus on HIV epidemic in the Asia-Pacific region. Viral suppression is estimated in children and adolescents, and adults on antiretroviral therapy (ART), incorporating adjustments for missing viral load measurements. Only 59% of children and adolescents and 65% of adults living with HIV had virological suppression at 3 years after ART. Notably, these proportions vary significantly across regions. These robust estimates enhance the understanding of treatment effectiveness in achieving viral suppression across diverse global contexts. Another investigation focuses on HIV treatment outcomes among individuals who acquired the virus through injecting drug use in the Asia-Pacific region. CD4 recovery and viral suppression improved over time after ART, despite the association of advanced HIV disease at ART initiation and sub-optimal adherence with the outcomes. The results illustrate unique challenges faced by this population and offer insights for tailored interventions and support systems. The impact of first-line integrase strand transfer inhibitors (INSTI) on CD4/CD8 ratio recovery is also explored. Compared to other ART regimens, those on INSTI experience higher CD4/CD8 ratio recovery and normalization rates, providing important insights for optimizing therapeutic strategies. Furthermore, the interplay between body mass index, immune recovery, virological failure, weight gain and cardiovascular disease (CVD) risk is investigated. Lastly, the incident liver cirrhosis, its associated factors, and CVD risks are studied. Individuals with liver cirrhosis are also found to have higher CVD risk scores, indicating the broader health implications of liver diseases in people with HIV. In conclusion, this thesis offers a comprehensive exploration of HIV treatment and health outcomes, spanning viral suppression, treatment response, immune recovery, metabolic factors, and long-term complications. The knowledge gained could inform strategies for optimizing HIV care globally and enhance the long-term well-being of people living with HIV