Epidemiology of HIV infection among adolescents in Uzbekistan: geographic disparities, delayed diagnosis, and virological control

Background/Objectives: Adolescents living with HIV face distinct challenges, including delayed diagnosis, suboptimal adherence, and gaps in continuity of care. This study assessed the epidemiological characteristics of HIV infection among adolescents in Uzbekistan, focusing on geographic distribution, delayed diagnosis, and virological control. Methods A retrospective population-based study used national AIDS center registry data for 6,447 adolescents aged 10–18 years with HIV infection. Demographic characteristics, clinical stage, viral load, ART coverage, and adherence were analyzed; delayed diagnosis was defined as detection at clinical stages III–IV. Proportions with 95% confidence intervals, relative risks, odds ratios, and a difference-in-differences analysis were used, with p<0.05 considered statistically significant. Results A total of 72.32% of adolescents were diagnosed at advanced stages (III–IV). The highest regional burden was in Andijan (37.65%; 95% CI: 36.40–38.80). Virological suppression (<500 copies/mL) was achieved in 68.80%, and 7.10% had a viral load >1000 copies/mL. Overall, 88.72% (95% CI: 87.93–89.47%) were receiving ART. In Syrdarya region, ART coverage rose from 80.87% to 90.09% (2023–2024; RR=1.114, 95% CI: 1.084–1.144; p<0.001), exceeding the increase in the rest of Uzbekistan by 4.04 percentage points (difference-in-differences, 95% CI: 1.74–6.33; p=0.0006). Conclusions HIV infection among adolescents in Uzbekistan is characterized by delayed diagnosis, regional clustering, and persistent gaps in virological control. Targeted, region-specific interventions focusing on early detection and adherence support are needed to improve outcomes and reduce transmission; further controlled evaluation using adolescent-specific outcomes is required before broader implementation of the proposed follow-up algorithm.