Viral suppression and immune recovery after antiretroviral therapy initiation in a Moroccan human immunodeficiency virus type 1-infected cohort: A retrospective analysis

Abstract

Introduction: Morocco has made substantial progress in expanding human immunodeficiency virus (HIV) testing and treatment, yet longitudinal data on immuno-virologic outcomes remain limited. Objective: We sought to define the clinical profile at presentation and analyze long-term immuno-virologic outcomes under expanding integrase inhibitor-based treatment. Methods: We performed a retrospective analysis of patients with confirmed HIV-1 infection who initiated antiretroviral therapy at the Center of Virology, Infectious, and Tropical Diseases at the Military Training Hospital between 2017 and 2025. Demographic, clinical, immunological, and virological data were collected at baseline and throughout follow-up. Statistical analyses were conducted using the Statistical Package for Social Sciences software. Results: Late presentation was common: 35.7% presented with Centers for Disease Control and Prevention stage C, and 41.5% had CD4 < 200 cells/μL. Women had higher baseline cluster of differentiation 4 (CD4) counts than men (416 vs. 250 cells/μL; p = 0.001), whereas men displayed higher viral loads (1.19 × 105 vs. 5.51 × 104 copies/mL; p = 0.005). Opportunistic infections remained substantial, including cytomegalovirus (16.5%), tuberculosis (12.5%), and toxoplasmosis (5.8%). First-line therapy was initially non-nucleoside reverse transcriptase inhibitor-based in half of the patients, but rapid national adoption of updated guidelines led to 93.8% receiving dolutegravir plus two nucleoside reverse transcriptase inhibitors at the last follow-up. Viral loads declined sharply within the first month, with most patients achieving and maintaining suppression from months 6–12 onward. CD4 counts rose from a median of 279 cells/μL at baseline to 560 at year 3, peaking at 610 at year 5 before stabilizing. Conclusion: Morocco’s transition to dolutegravir-based antiretroviral therapy has produced durable virologic control and robust immune recovery. Persistent late diagnosis, sex-based disparities, and limited access to genotyping remain major obstacles. Strengthening early testing, expanding molecular monitoring, and enhancing differentiated care services will be essential to sustain national progress.