Magnitude and Factors Associated with HIV Viral Suppression Among Adult People Living with HIV-HBV Co-Infection in Northwest Ethiopia

Background: HIV-HBV co-infection remains a major public health challenge, particularly in sub-Saharan Africa. HBV co-infection worsens clinical outcomes among people living with HIV by accelerating liver disease and complicating treatment. Although antiretroviral therapy can effectively suppress both viruses, achieving optimal HIV viral suppression remains critical for reducing morbidity and transmission. While several factors influencing viral suppression among PLHIV are well documented, evidence on HIV viral suppression among HIV-HBV co-infected individuals is limited, especially in resource-limited settings like Ethiopia. Furthermore, data on the magnitude of viral suppression and its associated factors in this population are scarce. Therefore, this study aimed to assess the magnitude of HIV viral suppression and identify its associated factors among adult HIV-HBV co-infected patients in Northwest Ethiopia. Objective: This study aimed to assess the magnitude and factors associated with HIV viral suppression among adult people living with HIV-HBV Co-infection in Northwest Ethiopia. Methods: An institution-based cross-sectional study was conducted in Northwest Ethiopia among adults with HIV-HBV co-infection on antiretroviral therapy. A simple random sample of 402 participants was selected. Data were collected using a pretested structured interviewer-administered questionnaire and medical record review, covering sociodemographic, clinical, behavioral, treatment, follow-up, and adherence factors. HIV viral suppression was defined as a plasma viral load < 1000 copies/mL. Data were coded in EpiData 4.6 and analyzed using STATA 18. Descriptive statistics estimated suppression rates. Bivariable and multivariable logistic regression identified factors associated with suppression; variables with p < 0.25 in bivariable analysis were included in the multivariable model. Statistical significance was set at p < 0.05 with adjusted odds ratios and 95% confidence intervals reported. Model fit was assessed using the Hosmer–Lemeshow test, and multicollinearity was checked using variance inflation factors. Results: There were 423 participants in all. Among the 423 HIV-HBV co-infected adults on antiretroviral therapy included in this study, 138 (34, CI, 30–39%) achieved HIV viral suppression, while 264 (66%) had an unsuppressed viral load at the time of assessment. Viral suppression was found to be independently correlated with the ART TDF-3TC-LPV/r regimen, first-line medication adherence, bedridden functional level, missed clinic appointments, and length of therapy. While TDF-3TC-LPV/r usage (AOR 2.34; 95% CI: 1.40–3.90) and longer treatment duration (AOR 2.09; 95% CI: 1.30–3.34) were advantageous, good adherence significantly improved the likelihood of suppression (AOR 5.54; 95% CI: 3.27–9.38). Missed appointments and a bedridden state decreased the likelihood of suppression. Conclusions: HIV viral suppression was achieved in only 34% of participants. Adherence, ART regimen, treatment duration, functional status, and retention in care were significant predictors. Strengthening adherence support, patient retention, optimized ART regimens, routine viral load monitoring, and targeted care for high-risk patients could improve treatment outcomes and help Ethiopia achieve UNAIDS viral suppression targets.