{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:54:19Z","timestamp":1785405259275,"version":"3.56.0"},"reference-count":29,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"S.D. Asfendiyarov Kazakh National Medical University"},{"id":[{"id":"https:\/\/ror.org\/05pc6w891","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Background: Virological suppression is a key outcome of antiretroviral therapy. Despite progress in HIV treatment in Kazakhstan, virological non-suppression remains a relevant clinical and public health issue requiring further analysis. This study aimed to assess the prevalence of virological suppression (VS) and to identify factors associated with the absence of VS among people living with human immunodeficiency virus (HIV) who are receiving antiretroviral therapy (ART) in Kazakhstan. Methods: A retrospective cross-sectional analytical study was conducted using secondary analysis of a de-identified national registry database of people living with HIV (PLHIV) receiving ART in the Republic of Kazakhstan as of 30 September 2025. The primary outcome was virological non-suppression (VNS), defined as the last viral load (VL) value of at least 200 copies per milliliter. The analysis included sex, age, presumed route of HIV transmission, the first available cluster of differentiation 4 (CD4) cell count recorded in the registry, the last recorded percentage category of adherence to ART, and the aggregated category of ART regimen. The main descriptive, bivariate, and multivariable analyses were performed using a complete-case approach. Independent associations were assessed using multivariable logistic regression, and the results were presented as adjusted odds ratios (aORs) with 95 percent confidence intervals (CIs). Results: The initial registry extraction included 33,614 records, of which 32,130 patients were included in the final analytical sample. VS was achieved in 29,454 (91.7%) patients, whereas VNS was observed in 2676 (8.3%) patients. In the multivariable model, higher adjusted odds of VNS were observed among men compared with women (aOR 1.14; 95% CI 1.02\u20131.26), as well as among patients with a first CD4 count &lt; 200 cells\/\u03bcL compared with those with a first CD4 count of \u2265500 cells\/\u03bcL (aOR 1.25; 95% CI 1.09\u20131.44). The strongest association was found for reduced adherence to therapy. Compared with adherence of at least 95%, the adjusted odds of VNS were markedly higher among patients with adherence of 85\u201394% (aOR 28.66; 95% CI 25.85\u201331.77) and among those with adherence below 85% (aOR 61.05; 95% CI 50.50\u201373.81). In all age groups older than 25 years, the adjusted odds of VNS were lower than among patients younger than 25 years. Lower adjusted odds of VNS were also observed among patients with homosexual transmission, vertical transmission, and other or unspecified transmission routes compared with heterosexual transmission. Among ART regimens, regimens containing non-nucleoside reverse transcriptase inhibitors (NNRTIs) were associated with lower adjusted odds of VNS than dolutegravir-containing regimens (DTG-containing regimens) (aOR 0.68; 95% CI 0.52\u20130.88), whereas no statistically significant differences were identified for regimens containing protease inhibitors (PIs). Conclusions: Despite the high overall level of VS among PLHIV receiving ART in Kazakhstan, VNS remains concentrated in clinically and programmatically important subgroups. It was most strongly associated with reduced adherence and was also associated with younger age, marked baseline immunosuppression, and male sex in the primary model. These findings support the need for targeted interventions focused on adherence support, early diagnosis, and differentiated long-term follow-up of patients.<\/jats:p>","DOI":"10.3390\/tropicalmed11060156","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:58:12Z","timestamp":1781053092000},"page":"156","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors Associated with Virological Non-Suppression Among People Living with HIV Receiving Antiretroviral Therapy in Kazakhstan: A National Registry-Based Study"],"prefix":"10.3390","volume":"11","author":[{"given":"Anel","family":"Ibrayeva","sequence":"first","affiliation":[{"name":"Department of Medicne, S.D. Asfendiyarov Kazakh National Medical University, Almaty 050000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9735-999X","authenticated-orcid":false,"given":"Zhamilya","family":"Nugmanova","sequence":"additional","affiliation":[{"name":"Department of Medicne, S.D. Asfendiyarov Kazakh National Medical University, Almaty 050000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anarkhan","family":"Nurkerimova","sequence":"additional","affiliation":[{"name":"Center for AIDS Control and Prevention, Almaty 050060, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aigerim","family":"Alimbekova","sequence":"additional","affiliation":[{"name":"Center for AIDS Control and Prevention, Almaty 050060, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marat","family":"Tukeyev","sequence":"additional","affiliation":[{"name":"Center for AIDS Control and Prevention, Almaty 050060, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfiya","family":"Denebaeva","sequence":"additional","affiliation":[{"name":"Center for AIDS Control and Prevention, Almaty 050060, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7307-0614","authenticated-orcid":false,"given":"Jack","family":"DeHovitz","sequence":"additional","affiliation":[{"name":"Department of Medicne, SUNY Downstate Health Sciences University, New York, NY 11203, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yerlan","family":"Ismoldayev","sequence":"additional","affiliation":[{"name":"Department of Medicne, S.D. Asfendiyarov Kazakh National Medical University, Almaty 050000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bolat","family":"Sadykov","sequence":"additional","affiliation":[{"name":"Department of Medicne, S.D. Asfendiyarov Kazakh National Medical University, Almaty 050000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shynar","family":"Tanabayeva","sequence":"additional","affiliation":[{"name":"Department of Medicne, S.D. Asfendiyarov Kazakh National Medical University, Almaty 050000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0528-3874","authenticated-orcid":false,"given":"Ildar","family":"Fakhradiyev","sequence":"additional","affiliation":[{"name":"Department of Medicne, S.D. Asfendiyarov Kazakh National Medical University, Almaty 050000, Kazakhstan"},{"name":"College of Medicine, Korea University, Seoul 02841, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"UNAIDS (2025). Global HIV & AIDS Statistics\u2014Fact Sheet, UNAIDS. Available online: https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/UNAIDS_FactSheet_en.pdf.","DOI":"10.18356\/9789211544350"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101243","DOI":"10.1016\/j.lanepe.2025.101243","article-title":"Control of HIV across the WHO European region: Progress and remaining challenges","volume":"52","author":"Parczewski","year":"2025","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_3","unstructured":"World Health Organization (2023). The Role of HIV Viral Suppression in Improving Individual Health and Reducing Transmission, World Health Organization. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240055179."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Shubber, Z., Mills, E.J., Nachega, J.B., Vreeman, R., Freitas, M., Bock, P., Nsanzimana, S., Penazzato, M., Appolo, T., and Doherty, M. (2016). Patient-reported barriers to adherence to antiretroviral therapy: A systematic review and meta-analysis. PLoS Med., 13.","DOI":"10.1371\/journal.pmed.1002183"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"18640","DOI":"10.7448\/IAS.16.3.18640","article-title":"Impact of HIV-related stigma on treatment adherence: Systematic review and meta-synthesis","volume":"16","author":"Katz","year":"2013","journal-title":"J. Int. AIDS Soc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e2540","DOI":"10.1002\/rmv.2540","article-title":"Prevalence and factors associated with viral non-suppression in people living with HIV receiving antiretroviral therapy in sub-Saharan Africa: A systematic review and meta-analysis","volume":"34","author":"Mosha","year":"2024","journal-title":"Rev. Med. Virol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Horne, R., Sabin, C., Chalder, T., Cooper, V., Campbell, L., Glendinning, E., Mosweu, I., and McCrone, P. (2025). Supporting Antiretroviral Therapy Uptake and Adherence: The SUPA Research Programme and RCT, National Institute for Health and Care Research. Programme Grants for Applied Research, No. 13.08.","DOI":"10.3310\/KPPW8401"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1089\/aid.2014.0011","article-title":"Lower baseline CD4 count is associated with a greater propensity toward virological failure in a cohort of South African HIV patients","volume":"30","author":"Costiniuk","year":"2014","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"UNAIDS (2025). 2025 Global AIDS Update\u2014Eastern Europe and Central Asia, UNAIDS. Available online: https:\/\/www.unaids.org\/sites\/default\/files\/2025-07\/2025-global-aids-update-eeca.pdf.","DOI":"10.18356\/9789211544350"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1111\/hiv.12603","article-title":"Monitoring the HIV continuum of care in key populations across Europe and Central Asia","volume":"19","author":"Brown","year":"2018","journal-title":"HIV Med."},{"key":"ref_11","unstructured":"UNAIDS (2025). Kazakhstan, Joint United Nations Programme on HIV\/AIDS. Available online: https:\/\/www.unaids.org\/en\/regionscountries\/countries\/kazakhstan."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"17195","DOI":"10.1038\/s41598-022-22163-7","article-title":"Antiretroviral therapy resistance mutations among HIV infected people in Kazakhstan","volume":"12","author":"Mukhatayeva","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Sanaubarova, A., Pujol-Hodge, E., Dzissyuk, N., Lemey, P., Vermund, S.H., Brown, A.J.L., and Ali, S. (2023). High-level drug-resistant mutations among HIV-1 subtype A6 and CRF02_AG in Kazakhstan. Viruses, 15.","DOI":"10.3390\/v15071407"},{"key":"ref_14","unstructured":"Panel on Antiretroviral Guidelines for Adults and Adolescents (2026, May 25). Virologic Failure and Antiretroviral Options. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. U.S. Department of Health and Human Services, Available online: https:\/\/clinicalinfo.hiv.gov\/en\/guidelines\/hiv-clinical-guidelines-adult-and-adolescent-arv\/virologic-failure."},{"key":"ref_15","unstructured":"UNAIDS Indicator Registry (2026, May 25). People Living with HIV Who Have Suppressed Viral Loads. Joint United Nations Programme on HIV\/AIDS. Available online: https:\/\/indicatorregistry.unaids.org\/."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Mustafa, A., Dzissyuk, N., Bayserkin, B., Begimbetova, D., Nugmanova, Z., and Ali, S. (2025). The need for the optimization of HIV antiretroviral therapy in Kazakhstan. Viruses, 17.","DOI":"10.3390\/v17050690"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"108690","DOI":"10.1016\/j.ijid.2026.108690","article-title":"The evolving HIV landscape in Central and Eastern Europe: Progress, gaps, and future directions\u2014Part I","volume":"168","author":"Vahabi","year":"2026","journal-title":"Int. J. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Magura, J., Nhari, S.R., and Nzimakwe, T.I. (2025). Barriers to ART adherence in sub-Saharan Africa: A scoping review toward achieving UNAIDS 95-95-95 targets. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1609743"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e26320","DOI":"10.1002\/jia2.26320","article-title":"Mental health and cognition in relation to adherence to antiretroviral therapy among people living with HIV in Kazakhstan: A cross-sectional study","volume":"27","author":"Mergenova","year":"2024","journal-title":"J. Int. AIDS Soc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1089\/aid.2015.0296","article-title":"Younger age predicts failure to achieve viral suppression and virologic rebound among HIV-1-infected persons in serodiscordant partnerships","volume":"32","author":"Mujugira","year":"2016","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1097\/COH.0000000000000880","article-title":"Adolescents and young adults with HIV and unsuppressed viral load: Where do we go from here?","volume":"19","author":"Rakhmanina","year":"2024","journal-title":"Curr. Opin. HIV AIDS"},{"key":"ref_22","unstructured":"Panel on Antiretroviral Guidelines for Adults and Adolescents (2026, April 15). Special Populations: Adolescents and Young Adults with HIV, Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV, Available online: https:\/\/clinicalinfo.hiv.gov\/en\/guidelines\/hiv-clinical-guidelines-adult-and-adolescent-arv\/special-populations-adolescents-young-adults."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Fernandez, D., Ali, H., Pals, S., Alemnji, G., Vasireddy, V., Siberry, G.K., Oboho, I., and Godfrey, C. (2023). Assessing sex differences in viral load suppression and reported deaths using routinely collected program data from PEPFAR-supported countries in sub-Saharan Africa. BMC Public Health, 23.","DOI":"10.1186\/s12889-023-16453-6"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e25889","DOI":"10.1002\/jia2.25889","article-title":"Men missing from the HIV care continuum in sub-Saharan Africa: A meta-analysis and meta-synthesis","volume":"25","author":"Nardell","year":"2022","journal-title":"J. Int. AIDS Soc."},{"key":"ref_25","unstructured":"World Health Organization (2023). Men and HIV: Evidence-Based Approaches and Interventions: A Framework for Person-Centred Health Services, World Health Organization. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240085794."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/S2055-6640(20)30037-6","article-title":"Associations between baseline characteristics, CD4 cell count response and virological failure on first-line efavirenz + tenofovir + emtricitabine for HIV","volume":"5","author":"Stirrup","year":"2019","journal-title":"J. Virus Erad."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Afrashteh, S., Fararouei, M., Ghaem, H., and Gheibi, Z. (2022). Factors associated with late antiretroviral therapy initiation among people living with HIV in Southern Iran: A historical cohort study. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.881069"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1186\/s12981-025-00788-8","article-title":"High HIV viral suppression among adults receiving WHO-recommended first-line dolutegravir-based antiretroviral therapy in low- and middle-income countries: A systematic review and meta-analysis of programmatic evidence","volume":"22","author":"Lorenzana","year":"2025","journal-title":"AIDS Res. Ther."},{"key":"ref_29","unstructured":"World Health Organization (2026, April 15). HIV Drug Resistance. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/hiv-drug-resistance."}],"container-title":["Tropical Medicine and Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-6366\/11\/6\/156\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T02:00:30Z","timestamp":1781056830000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-6366\/11\/6\/156"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,9]]},"references-count":29,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["tropicalmed11060156"],"URL":"https:\/\/doi.org\/10.3390\/tropicalmed11060156","relation":{},"ISSN":["2414-6366"],"issn-type":[{"value":"2414-6366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,9]]}}}