Low-Income Status and Opportunistic Infections as Factors for Unsuppressed Viral Load in Timor-Leste

Dear Editors:

The study "Factors Associated with Viral Load Non-Suppression among People Living with HIV on Antiretroviral Therapy in Dili, Timor-Leste," by Tilman, Damas, and Choi, is extremely valuable because it provides crucial baseline epidemiological data in an area where such data is extremely limited [1]. The study systematically analyzes important risk variables among persons living with human immunodeficiency virus (HIV) undergoing antiretroviral medication (ART) and focuses on the prevalence of viral load non-suppression. This is crucial because viral non-suppression directly undermines worldwide "Undetectable=Untransmittable" goals by increasing morbidity, death, and the risk of medication resistance.

Tilman et al. associate poor viral suppression with low-middle-income status (poverty, transport) and clinical elements (low CD4 count, TB), emphasizing gaps in early detection and integrated care.

This study offers data from low-resource regions like Timor-Leste, emphasizing knowledge gaps for focused public health policies. The evidence aids comparable developing countries in tailoring interventions (e.g., nutritional support, decentralized dispensing) to develop treatment success and reach global HIV goals.

To overcome the limitations of a single-center, small sample size, and retrospective design, future research should focus on a multi-center, prospective longitudinal study [1]. Therefore, research must study social support and decentralized ART efficacy on viral suppression.

Given the same socioeconomic and healthcare issues, the study's conclusions directly affect the Philippines, despite the fact that it was carried out in Timor-Leste. According to the Philippine Statistics Authority, the poverty incidence among families was registered at 10.9%, or the equivalent of 3.0 million poor families, in 2023 [2]. Poverty incidence is the proportion of Filipino families with incomes that are not sufficient to buy their minimum basic food and non-food needs as estimated by the poverty threshold. At the individual level, 15.5% of Filipinos, or about 17.54 million Filipinos, were poor in 2023. In the Philippines, where poverty and socioeconomic inequality can pose serious obstacles to regular access to healthcare and treatment compliance, the study's focus on low-middle-income status as a potential risk factor is extremely relevant. Given that 252,800 Filipinos are expected to be living with HIV in 2025, according to the World Health Organization, and considering the significant number of TB cases in the Philippines, it is especially crucial to identify links between infectious diseases like TB and viral non-suppression. The study highlights the need for integrated care approaches that simultaneously treat HIV and co-infections. The study ultimately offers a framework for the Philippines to strengthen its public health strategy by focusing on improved follow-up, adherence support, and decentralized care to increase viral suppression rates and move closer to international HIV goals.

Achieving global HIV targets requires a holistic approach, prioritizing decentralized care and social support to overcome socioeconomic barriers, ensuring treatment adherence, and empowering individuals for national productivity.