Impact of baseline CD4 count on virologic suppression outcomes in people living with HIV on ART at Cibinong District Hospital

Background: Human immunodeficiency virus (HIV) remains a global health challenge, with viral suppression targets yet to be optimally achieved. A low baseline CD4 count at the initiation of therapy reflects immune system damage and increases the risk of viral suppression failure. This study aimed to assess the effect of baseline CD4 count on viral suppression failure among people living with HIV (PLHIV) receiving antiretroviral therapy (ART) at Cibinong District Hospital, Bogor Regency. Methods: This case-control study utilized secondary data from electronic medical records. The study population included PLHIV who had been on ART for at least six months and had viral load (VL) results between November 2022 and March 2025 that met the inclusion and exclusion criteria. A total of 106 cases (VL>50 copies/ml) were selected through total sampling, while 212 controls (VL≤50 copies/ml) were randomly chosen. Multivariate logistic regression with a risk factor model was used for analysis. Results: The findings revealed that 25.4% of PLHIV experienced viral suppression failure, the majority of whom had a baseline CD4 count <100 cells/mm³. Low baseline CD4 count significantly increased the risk of viral suppression failure (OR 4.5; 95% CI: 1.48-13.62) after adjusting for confounders (treatment duration, baseline BMI, CD4 change, baseline Hb, risk behaviors, TB history, and treatment adherence). An interaction was also identified between baseline CD4 count, nutritional status, and TB history, which further amplified the risk of viral suppression failure. Conclusions: These findings underscore the importance of baseline CD4 testing at therapy initiation as a risk indicator. Early integration of HIV, TB, and nutrition services is essential to suppress viral replication and improve the quality of life of PLHIV.