Sex-specific clinical predictors of viral suppression in HIV-positive adults: adherence, anemia, and prior virologic control

While viral suppression is the central goal of antiretroviral therapy (ART), persistent disparities in treatment outcomes exist. Understanding whether the predictors of suppression differ by sex is essential for tailoring interventions and achieving equitable care in high-burden settings like Zambia. Among 384 participants (130 males, 254 females), suppression was higher in females (91.7%) than males (87.7%). Poor ART adherence (missing ≥ 2 doses in 30 days) was the strongest predictor of unsuppressed viremia for both sexes ( p < 0.0001). Sex-specific predictors were identified: for males, lower hemoglobin levels were independently associated with unsuppressed status (aOR: 1.50 per g/dL increase, 95% CI: 1.00–2.26; p = 0.049). For females, a suppressed viral load prior to regimen switching strongly predicted current suppression (OR: 3.67, 95% CI: 1.47–9.15; p = 0.005). History of opportunistic infections and certain prior ART regimens showed associations in unadjusted analyses but were attenuated after adjustment.