# Real-World Outcomes of Antiretroviral Therapy in People Living With HIV in Saudi Arabia: A Three-Year Observational Cohort Study From a Tertiary Care Center

## TL;DR

This study shows that antiretroviral therapy effectively reduces HIV transmission risk in Saudi Arabia over three years.

## Contribution

Demonstrates real-world effectiveness of newer ARTs in achieving undetectable viral load in Saudi Arabia.

## Key findings

- 616 out of 700 patients achieved undetectable viral load (U = U) after three years of ART.
- Bictegravir/emtricitabine/tenofovir (B/F/TAF) was the most prescribed and effective ART regimen.
- High adherence (>95%) and no treatment discontinuations due to side effects were observed.

## Abstract

Background: Treatment adherence is an essential determinant in the management of HIV. In an observational cohort study in Saudi Arabia, the clinical outcomes of antiretroviral therapy (ART) in terms of viral suppression and treatment adherence were evaluated among people living with HIV.

Method: In an open, single-center, observational cohort study, 700 patients were enrolled and followed for three years, either in person or virtually. The study aimed to help patients transition to the U = U (undetectable = untransmittable) category as per the Preventive Access Campaign. The viral load was estimated every three months. Treatment adherence was calculated based on the number of missed doses by the patients.

Results: In this observational cohort study, 700 patients received ART treatment of various types. The patients presented varying disease durations ranging from one to 20 years. The triple drug combination comprising bictegravir/emtricitabine/tenofovir (B/F/TAF) was the most prescribed ART. At the end of 36 months, 616 patients reached the U = U category. A significant reduction in viral load was observed at 12, 24, and 36 months from baseline (p < 0.05; 95% confidence interval (CI)). All patients tolerated the ART, and there were no treatment discontinuations due to side effects. The average treatment adherence was more than 95% across all the cohorts. An increase in viral load was observed with missing doses; however, the newer ARTs effectively controlled viral load during the ART-reduced adherence.

Conclusions: HIV is treatable, and with effective treatment, patients can achieve “untransmittable” status. This study demonstrates the effectiveness of the newer ARTs in HIV management in Saudi Arabia.