Prevalence and factors associated with HIV viral rebound in individuals on ART: A systematic review study

Abstract

Background: Viral rebound (VR), the resurgence of detectable human immunodeficiency virus (HIV) viral loads (> 50 copies/mL) after suppression, remains a challenge for individuals on antiretroviral therapy (ART) in South Africa, despite free access to treatment. Aim: This systematic review aimed to determine the prevalence of HIV VR and its contributing factors among individuals on ART. Setting: This is a systematic review study, it relies primarily on secondary data, and it does not have a physical setting. Method: This study is conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane methodology, and the study was registered with PROSPERO (ID: CRD42024524121). Data were sourced from PubMed, EBSCOhost and Scopus, yielding 89 684 articles. After screening in Rayyan, 23 articles met the inclusion criteria. The risk of bias was assessed using the Joanna Briggs Institute’s (JBI’s) appraisal tool. Results: Viral rebound varies across different populations. Contributing factors included biological, genetic, demographic, socio-economic and structural elements, as well as incarceration, missed appointments, lifestyle behaviours, travel, multiple sexual partners, ART regimen, age and clinical management. Poor ART adherence emerged as a key driver. Conclusion: Human immunodeficiency virus viral rebound results from a combination of biological, social and treatment-related factors, with non-adherence to ART being a major contributor. The study highlights the need for improved adherence strategies to reduce VR. Contribution: This review enhances the understanding of HIV VR prevalence and its contributing factors, while also providing recommendations to mitigate these factors.