Assessment of the effectiveness of antiretroviral therapy in the Russian Federation in 2023

Study objective: To assess the potential therapeutic and prophylactic efficacy of antiretroviral therapy (ART) achieved in Russia in 2023.

Materials and methods. Responses to questions on ART monitoring in response to a special Rospotrebnadzor request, «On the Causes of HIV Infection and Causes of HIV-Associated Mortality in the Russian Federation» for 2022―2023 were collected from 89 constituent entities of the Russian Federation.

Results. In 2023, 826,108 HIV-infected patients were registered for follow-up care (24,043 of them in four recently reunified regions). CD4 cell count coverage was 90.3% (23.8% in the reunified regions), and ART coverage was 88.8% and 78.4%, respectively. The number of HIV RNA copies in the blood (viral load, VL) below the detection level was observed in 55.3% of those registered for dispensary care and in 67.7% of those receiving ART (in the reunited regions, the figures are 18.9% and 32.6%, respectively). Of the 733,356 patients who started ART in 2023, 73.3% were tested for VL. VL was below the detection level in 92.3% of those tested (67.7% of those receiving ART). Virological failure of ART was confirmed in 6,654 people. Of these, 68.8% were switched to second-line ART regimens. 5.2% of patients discontinued ART (including due to death) in 2023. In the four reunified regions of the Russian Federation, almost all indicators of HIV care and treatment coverage, laboratory monitoring of its effectiveness, and resistance development were lower than the national average.

Conclusion. Not all HIV-positive Russians under observation follow-up and receiving ART are receiving ART efficacy monitoring based on changes in CD4 cell counts and viral load. Not all achieve undetectable viral loads. Furthermore, many patients with detectable viral loads do not change their ART regimen. Therefore, the effectiveness of ART for both treatment and prevention of HIV transmission remains insufficient.