During the years 1995 to 2019 (25 years), 2867 patients were infected with HIV/AIDS, of which 2449 (85.42%) were male. The average age of the study population was 33.47 (95% CI: 33.92-34.02), which was almost the same for men and women. The mean age of HIV/AIDS in women was 33.94 (95% CI: 32.70-35.17) per year and in men was 33.36 (95% CI: 32.66-34.06) per year.
The mean duration of HIV/AIDS in women was 11.54 years (95% CI: 10.76-12.32) and in men was 11.89 (95% CI: 11.44-12.35). According to the WHO classification, 185 patients (6.45%) were identified in stage 4 (AIDS). During the study period, 1591 patients died, the most important causes of death being AIDS, suicide and substance abuse, respectively, and AIDS-related infections were 354 (36.9%), 178 (18.5%) and 110 (11.4%), respectively. Of the 1,276 living patients in this study, 773 (60.58%) patients are currently receiving ARV treatment.
Among patients with HIV/AIDS, 98 (3.42%), 394 (13.74%) and 776 (27.07%) had HBV, HCV, and TB infections, respectively. Among the risk factors for HIV/AIDS are 2143 (74.75%) History of drug abuse, 1967 (68.61%) History of injection drug, 1693 (59.05%) history of the prison, 1584 (55.25%) needle sharing, 1336 (46.60%) unsafe sexual behavior and 716 (24.97%) sex with non-spouse (Table 1).
In terms of treatment status, 1817 people with HIV/AIDS (63.38%) were non-adherence to medication and 783 (27.31%) were adherence to ARV, and the rest had cessation of ARV. As Table 1 shows, adherence to ARV increased in women, married people, and with age and education. Also, those who did not have needle sharing, history of drug abuse, history of injection drug use, history of the prison, sex with non-spouse, and unsafe sexual behavior had a higher percentage of adherence to treatment than those who had these behavioral risk factors (Table 1).
Table 1: Demographic characteristics and behavioral risk factors of people with HIV/AIDS according to the status of antiretroviral treatment pattern.
P value
|
Cessation of ARV
|
Adherence to ARV
|
Non-adherence to ARV
|
Total (%)
|
Characteristics/Infection status
|
267(9.31)
|
783(27.31)
|
1817(63.38)
|
2867(100)
|
Total (%)
|
<0.001
|
39(9.33)
|
254(60.77)
|
125(29.90)
|
418(14.58)
|
Female
|
Gender
|
228(9.31)
|
529(21.60)
|
1692(69.09)
|
2449(85.42)
|
Male
|
0.054
|
33(7.10)
|
121(26.02)
|
311(66.88)
|
465(16.22)
|
<18
|
Age
|
127(9.61)
|
346(26.17)
|
849(64.22)
|
1322(46.11)
|
19-29
|
74(9.28)
|
223(27.98)
|
500(62.74)
|
797(27.80)
|
30-40
|
33(11.66)
|
93(32.86)
|
157(55.48)
|
283(9.87)
|
>41
|
<0.001
|
147(10.78)
|
456(33.43)
|
761(55.79)
|
1364(47.58)
|
Unemployed
|
Job
|
120(7.98)
|
327(21.76)
|
1056(70.26)
|
1503(52.42)
|
employed
|
<0.001
|
26(9.39)
|
57(20.58)
|
194(70.04)
|
277(9.66)
|
illiterate
|
Educational
|
59(8.43)
|
200(28.57)
|
441(63.00)
|
700(24.42)
|
Elementary
|
109(11.61)
|
270(28.75)
|
560(59.64)
|
939(32.75)
|
guidance
|
55(9.84)
|
250(44.72)
|
254(45.44)
|
559(19.50)
|
High school and above
|
18(4.59)
|
6(1.53)
|
368(93.88)
|
392(13.67)
|
Unknown
|
<0.001
|
112(8.75)
|
257(20.08)
|
911(71.17)
|
1280(44.65)
|
Single
|
Marital status
|
83(9.64)
|
355(41.23)
|
423(49.13)
|
861(30.03)
|
Married
|
62(11.33)
|
147(26.87)
|
338(61.97)
|
547(19.08)
|
Widow /divorce
|
10(5.59)
|
24(13.41)
|
145(81.01)
|
179(6.24)
|
Unknown
|
<0.001
|
130(8.60)
|
264(17.47)
|
1117(73.92)
|
1511(52.70)
|
≤200
|
CD4 cell count (cells/μl)
|
137(10.10)
|
519(38.27)
|
700(51.62)
|
1356(47.30)
|
>200
|
<0.001
|
122(8.13)
|
174(11.60)
|
545(42.95)
|
1269(44.26)
|
No
|
HBV*
|
10(10.20)
|
20(20.41)
|
68(69.39)
|
98(3.42)
|
Yes
|
135(10.64)
|
589(46.41)
|
1204(80.27)
|
1500(52.32)
|
Unknown
|
<0.001
|
135(10.75)
|
535(42.60)
|
586(46.66)
|
1256(43.81)
|
No
|
HCV*
|
64(16.24)
|
146(37.06)
|
184(46.70)
|
394(13.74)
|
Yes
|
68(5.59)
|
102(8.38)
|
1047(86.03)
|
1217(42.45)
|
Unknown
|
<0.001
|
205(9.80)
|
639(30.56)
|
1247(59.64)
|
2091(72.93)
|
No
|
TB*
|
62(7.99)
|
144(18.56)
|
570(73.45)
|
776(27.07)
|
Yes
|
<0.001
|
149(9.41)
|
317(20.01)
|
1118(70.58)
|
1584(55.25)
|
Yes
|
Needle sharing
|
10(12.05)
|
28(33.73)
|
45(54.22)
|
83(2.90)
|
No
|
108(9.41)
|
438(36.50)
|
654(54.50)
|
1200(41.86)
|
Unknown
|
<0.001
|
208(9.71)
|
449(20.95)
|
1486(69.34)
|
2143(74.75)
|
Yes
|
History of drug abuse
|
35(7.83)
|
325(72.71)
|
87(19.46)
|
447(15.59)
|
No
|
24(8.66)
|
9(3.25)
|
244(88.09)
|
277(9.66)
|
Unknown
|
<0.001
|
182(9.25)
|
352(17.90)
|
1433(72.85)
|
1967(68.61)
|
Yes
|
History of injection drug
use
|
25(14.20)
|
82(46.59)
|
69(39.20)
|
176(6.14)
|
No
|
60(8.29)
|
349(48.20)
|
315(43.51)
|
724(25.25)
|
Unknown
|
<0.001
|
164(9.69)
|
409(24.16)
|
1120(66.15)
|
1693(59.05)
|
Yes
|
History of the prison
|
50(8.40)
|
364(61.18)
|
181(30.42)
|
595(20.75)
|
No
|
53(9.15)
|
10(1.73)
|
516(89.12)
|
579(20.20)
|
Unknown
|
<0.001
|
71(9.92)
|
257(35.89)
|
388(54.19)
|
716(24.97)
|
Yes
|
sex with non-spouse
|
28(9.69)
|
213(73.70)
|
48(16.61)
|
289(10.08)
|
No
|
168(9.02)
|
313(16.81)
|
1381(74.17)
|
1862(64.95)
|
Unknown
|
<0.001
|
132(9.88)
|
479(35.85)
|
725(54.27)
|
1336(46.60)
|
Yes
|
Unsafe sexual behavior
|
72(9.63)
|
286(38.24)
|
390(52.14)
|
748(26.09)
|
No
|
63(8.05)
|
18(2.30)
|
702(89.38)
|
783(27.31)
|
Unknown
|
<0.001
|
24(5.37)
|
156(34.90)
|
267(59.73)
|
447(15.59)
|
Stage 1
(asymptomatic)
|
WHO Clinical Staging of HIV/AIDS
|
68(10.43)
|
409(62.73)
|
175(26.84)
|
652(22.74)
|
Stage 2
|
77(16.14)
|
134(28.09)
|
266(55.77)
|
477(16.64)
|
Stage 3
|
48(25.95)
|
67(36.22)
|
70(37.84)
|
185(6.45)
|
Stage 4 (AIDS)
|
50(4.52)
|
17(1.54)
|
1039(93.94)
|
1106(38.58)
|
Unknown
|
* Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Tuberculosis (TB).
The HIV/AIDS treatment trend shows that in 1995, more than 90 percent of people were non-adherent to treatment, while in 2019, more than 67 percent of those studied were adherence to treatment, the treatment process has been on the rise since 2005, the trend of cessation of treatment between 1995 and 2019 was almost constant and close to 8%. (Figure 2).
All behavioral risk factors increased non-adherence to treatment. In general, after controlling the confounding variables except needle sharing, all behavioral variables affected adherence; The greatest impact was on non-adherence with treatment in History of drug abuse, History of the prison, History of injection drug use and Sex with non-spouse with a chance of 10.87 (7.21-16.39), 3.94 (2.84-5.46), 3.86 (2.47-6.03) and 3.38 (2.19-5.23) times more than patients without this risk factors to follow the treatment (Table 2).
Although the effect of behavioral risk factors on cessation of treatment was not as significant as non-adherence to treatment, after controlling the variables of the disorder, the most important factors in cessation of treatment were observed in patients with a history of drug use and history of the prison. The chances of cessation of treatment in patients with a history of drug use and history of the prison were 4.15 (2.37-7.25) and 2.21 (1.35-3.61) times higher than in patients without these risk factors in adherence to ARV, respectively (Table 2).
Table 2. Results of the crude and adjusted multivariate logistic regression analysis of non-adherence and cessation compared to adherence to antiretroviral therapy.
Model 3
OR(95%CI)
|
Model 2
OR(95%CI)
|
Model 1
OR(95%CI)
|
Model 0
OR(95%CI)
|
Behavioral Risk factors
|
|
1
|
1
|
1
|
1
|
No
|
History of drug abuse
|
Non-adherence to ARV compared to adherence to antiretroviral therapy
|
10.87(7.21-16.39)
|
9.38(6.42-13.72)
|
9.75 (6.99-13.60)
|
12.36(9.54-16.02)
|
Yes
|
72.04(32.12-161.57)
|
75.34(34.95-162.42)
|
79.78(38.29-166.21)
|
101.27(49.99-205.19)
|
Unknown
|
1
|
1
|
1
|
1
|
No
|
Needle sharing
|
1.40(0.80-2.47)
|
1.58(0.91-2.74)
|
2.15(1.31-3.53)
|
2.19(1.35-3.57)
|
Yes
|
0.99(0.55-1.79)
|
1.27(0.72-2.22)
|
1.55(1.-1.06)
|
0.93(0.57-1.51)
|
Unknown
|
1
|
1
|
1
|
1
|
No
|
History of injection drug
use
|
3.86(2.47-6.03)
|
3.42(2.28-5.14)
|
3.53(2.46-5.05)
|
4.84(3.44-6.80)
|
Yes
|
1.02(0.64-1.63)
|
1.22(0.80-1.87)
|
1.25(0.86-1.82)
|
1.07(0.75-1.52)
|
Unknown
|
1
|
1
|
1
|
1
|
No
|
History of the prison
|
3.94(2.84-5.46)
|
3.27(2.42-4.42)
|
3.47(2.68-4.51)
|
5.51(4.46-6.80)
|
Yes
|
60.67(29.82-123.48)
|
67.84(34.13-134.85)
|
68.80(35.39-133.75)
|
103.77(54.14-198.91)
|
Unknown
|
1
|
1
|
1
|
1
|
No
|
sex with non-spouse
|
3.38(2.19-5.23)
|
3.87(2.55-5.89)
|
3.81(2.61-5.57)
|
6.70(4.72-9.51)
|
Yes
|
8.27(5.47-12.50)
|
10.53(7.08-15.66)
|
11.59(8.09-16.61)
|
19.58(13.99-27.41)
|
Unknown
|
1
|
1
|
1
|
1
|
No
|
Unsafe sexual behavior
|
1.53(1.19-1.96)
|
1.35(1.07-1.70)
|
1.19(0.97-1.46)
|
1.11(0.92-1.34)
|
Yes
|
27.23(15.93-46.55)
|
25.48(15.21-42.67)
|
24.22(14.70-39.90)
|
28.6(17.48-46.78)
|
Unknown
|
1
|
1
|
1
|
1
|
No
|
History of drug abuse
|
Cessation of ARV compared to Adherence to antiretroviral therapy
|
4.15(2.37-7.25)
|
3.83(2.22-6.59)
|
3.93(2.34-6.59)
|
4.30(2.92-6.32)
|
Yes
|
0.63(0.34-1.17)
|
24.01(9.76-59.53)
|
26.19(1.87-63.08)
|
24.76(10.67-57.45)
|
Unknown
|
1
|
1
|
1
|
1
|
No
|
Needle sharing
|
1.15(0.50-2.62)
|
1.21(0.56-2.63)
|
1.28(0.61-2.73)
|
1.32(0.62-2.78)
|
Yes
|
0.82(0.35-1.94)
|
1.05(0.47-2.34)
|
1.01(0.47-2.21)
|
0.69(0.32-1.46)
|
Unknown
|
1
|
1
|
1
|
1
|
No
|
History of injection drug
use
|
1.64(0.95-2.84)
|
1.43(0.86-2.40)
|
1.63(1.00-2.67)
|
1.69(1.04-2.75)
|
Yes
|
0.63(0.34-1.17)
|
0.67(0.37-1.20)
|
0.71(0.40-1.25)
|
0.56(0.33-0.95)
|
Unknown
|
1
|
1
|
1
|
1
|
No
|
History of the prison
|
2.21(1.35-3.61)
|
1.98(1.24-3.17)
|
2.22(1.41-3.51)
|
2.91(2.06-4.13)
|
Yes
|
21.54(9.42-49.24)
|
31.21(14.26-68.34)
|
34.17(15.82-73.80)
|
38.58(18.45-80.67)
|
Unknown
|
1
|
1
|
1
|
1
|
No
|
sex with non-spouse
|
1.53(0.89-2.62)
|
1.59(0.94-2.69)
|
1.45(0.86-2.42)
|
2.10(1.31-3.37)
|
Yes
|
2.51(1.52-4.12)
|
3.13(1.94-5.06)
|
3.13(1.96-4.99)
|
4.08(.64-6.32)
|
Unknown
|
1
|
1
|
1
|
1
|
No
|
Unsafe sexual behavior
|
1.37(0.95-1.96)
|
1.24(0.88-1.74)
|
1.18(0.85-1.65)
|
1.09(0.79-1.51)
|
Yes
|
11.09(5.5-21.37)
|
13.85(7.48-25.67)
|
14.52(7.94-26.54)
|
13.90(7.75-24.93)
|
Unknown
|
OR, odds ratio; CI, confidence interval.
Model 0 the crude odds ratio with 95% confidence interval of risk factors.
Model 1, adjusted for gender, age, job, educational, marital status.
Model 2, adjusted for model 1, HBV, HCV, TB.
Model 3, adjusted for model 2, CD4, WHO stages.
In general, Viral Load level varied in different behavioral risk factors in individuals who cessation of treatment or non-adherence to ARV (P <0.001), so that the VL level was lower significantly among patients who had cessation or non-adherence to ARV. But it was almost the same in the people who were adherence to treatment ARV (P = 0.19). The highest VL level in patients who were non-adherent to treatment is related to individuals who had sex with non-spouse. Moreover, the highest VL level in patients who had cessation of treatment is for the history of injection drug use (Figure 3).