New Study Yields Insights to Women Living with HIV/AIDS, and Viral Suppression

By: Ranier Simons, ADAP Blog Guest Contributor

The goal of HIV antiretroviral therapy (ART) is viral suppression. Viral suppression is reducing the level of HIV in the blood to an undetectable status. Viral suppression is achieved through strict adherence to antiretroviral therapy (ART) regimens in their various forms. Insufficient adherence can result in increased viral loads or even virological drug resistance. As advances in ART continue, it is essential to determine the level of adherence considered sufficient for viral suppression. In a perfect world, all people living with HIV/AIDS would have 100 percent adherence to treatment regimens, meaning that they never missed a dose. That is not realistic. Thus, consensus in medical science views 95% as a high level of adherence. Even 95% adherence is not achievable for many people living with HIV/AIDS (PLWHA). Because data show that viral suppression can be achieved with adherence of less than 95% using newer medications, scientists are investigating the levels of adherence required for this outcome. A recent Canadian study examined viral suppression and treatment adherence among women, taking into account the unique characteristics of many women’s lived experiences (Mokaddam et al., 2025).

Photo Source: HIVinfo | NIH

Presently, ART is lifelong. Thus, effective treatment requires consistent and ongoing adherence. Women living with HIV/AIDS (WLWHA) have unique social, biological, and other categories of lived experience that result in unique challenges to ART adherence (Ogden et al., 2004). Canadian researchers performed a longitudinal study of WLWHA because 2020 data showed women lagged behind men concerning the Joint United Nations Programme on HIV/AIDS target for HIV care. The target is 95-95-95, meaning 95% of all PLWHA should be aware of their status, 95% of those diagnosed should be on effective therapy, and 95% of those on ART should have viral suppression (Mokaddam et al., 2025). PLWHA Data from 2020 shows men at target levels of 90%–87%–96% and women at 88%–85%–90% (Mokaddam et al., 2025). 

The Canadian study utilized data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS), a community-based, prospective cohort study. The CHIWOS study was conducted in three waves from 2013 to 2018. The recent Canadian study executed a longitudinal analysis of self-reported survey data, including socioeconomic data, health history including HIV and ART, substance abuse, and even history of violence and abuse (Mokaddam et al., 2025). The researchers specifically included subjects only if they reported utilizing a regimen consisting of an antiretroviral backbone with a third agent. The ‘backbone’ consists of two nucleoside reverse transcriptase inhibitors (NRTIs). The backbone is then combined with a third medication chosen from several classes, including non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), or integrase strand transfer inhibitors (INSTIs) (HIV.Gov, n.d.). The researchers made this distinction as a standard for inclusion to rule out other forms of ART that may be prescribed due to previous drug resistance or other drug interactions and conditions to lower the possibility of confounding factors affecting adherence.

Photo Source: HIV.gov

The cross-sectional analysis of the third wave of participants revealed that overall, 95.5% reported viral suppression, and 76.2% of participants had an ART adherence level of ≥ 95% (Mokaddam et al., 2025). Of those reporting ≥95% adherence, 97% of those achieved viral suppression. Other levels of reported adherence were associated with different viral suppression percentages. Respondents who reported 85-89% adherence had a viral suppression of 78.6%, those with 75-79% adherence had a viral suppression of 75%, and those with less than 65% reported a viral suppression of 76.5% (Mokaddam et al., 2025). Those reporting 90-94% adherence to ART had a viral suppression level of 97.2%, similar to that of those with ≥95% adherence. There were no differences in the odds of participants reporting viral suppression across the various medications used as a third agent to the ART backbone. Approximately 27.2% were on a first-generation INSTI, 34.0% on a second-generation INSTI, 22.9% on a NNRTI, and 15.9% were on a PI (Mokaddam et al., 2025). 

This Canadian study suggests that the odds of achieving viral suppression with adherence rates of 90% or less are significantly lower than those with adherence rates of 95% or higher. Several studies have indicated that viral suppression can be achieved with adherence levels of 75% to 80%. Interestingly, the study observed an increase in the utilization of INSTIs as a third agent, specifically dolutegravir, over the course of the waves between 2013 and 2018 (Mokaddam et al., 2025). The use of dolutegravir increased the odds of virologic suppression (VS) across varying levels of adherence.

WLWHA have unique issues to deal with that affect their ability to maintain treatment adherence. Medication access, living situations, women-specific health conditions, and many other factors influence the ability to engage in care. It is imperative to continue exploring the impact of their lived experience on their ability to maintain adherence, coupled with the development of ART that is more forgiving in terms of the levels of adherence required to maintain viral suppression. This data is vital for women as well as PLWHA as a whole.

[1] Mokaddam, M., Kronfli, N., Sheehan, N. L., Reyes, A. G., Dubuc, D., Loutfy, M., Kaida, A., & De Pokomandy, A. (2025). Antiretroviral therapy use, self‐reported adherence, and viral suppression among women living with HIV in Canada. HIV Medicine. https://doi.org/10.1111/hiv.70034. Retrieved from https://onlinelibrary.wiley.com/doi/10.1111/hiv.70034

[2] NIH Office of AIDS Research (HIV.Gov). (n.d.). HIV/AIDS Glossary: Backbone. Retrieved from https://clinicalinfo.hiv.gov/en/glossary/backbone

[3] Ogden, L., Ogden, J., Mthembu, P., & Williamson, N. (2004). Impact of HIV on women internationally. Emerging infectious diseases, 10(11), 2032–2033. https://doi.org/10.3201/eid1011.040624_01. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC3329028/

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