Pre-conflict prescription patterns and virological effectiveness of combination antiretroviral therapy (cART) in HIV-1 patients in Tigray, Ethiopia

Abstract Background Limited evidence exists on the prescription patterns of combination antiretroviral therapy (cART) and their effectiveness in achieving HIV-1 viral suppression. This study evaluated pre-conflict prescription patterns of cART and their virological effectiveness among HIV-1 patients. Methods A retrospective, cross-sectional analysis was conducted among 7,689 patients with complete virological and clinical data extracted from the THRI database, covering the pre-war period from July 2018 to October 2020. The data were entered, cleaned, and analyzed using SPSS version 25. Associations between categorical variables and virological outcomes were assessed using Pearson’s χ² test. Results Among 7,689 HIV-1-infected individuals on ART (mean age: 43 ± 13 years; 64.4% female), first-line regimens were predominantly prescribed (91.1%), with strong adherence observed in 73.3% of cases. The most commonly used current regimen was 1 J (53.8%), while initial regimens included 1 C (32.9%), 1E (32.1%), and 1 A (21.6%). Overall, virological suppression was higher among females (4,597, 92.7%) than among males (2,392, 87.5%). Factors significantly associated with viral suppression included female sex, younger age, longer duration on ART, earlier clinical stage, higher CD4 counts, strong adherence, consistent follow-up, and timely regimen switching. Conclusion This study demonstrates that favorable virological outcomes are strongly associated with patient sex, age, treatment duration, baseline clinical and immunological status, and adherence. The findings underscore the importance of early initiation, individualized regimen optimization, and enhanced support for males and individuals with advanced disease. Strengthening adherence programs, introducing genomic surveillance, and performing in-depth longitudinal studies to evaluate the impact of the war are also timely to further improve treatment outcomes, HIV care revitalization, and curb transmission.