Abstract / Summary
Human Immunodeficiency Virus (HIV) infection remains a major public health burden, particularly in resource-limited settings. This study delineates the epidemiological, clinical, immuno-virological, and therapeutic profiles of newly diagnosed HIV patients at a Moroccan tertiary care center in 2023. This prospective cohort study enrolled 396 newly diagnosed HIV-positive individuals at Ibn Rochd University Hospital, Casablanca, between January 1 and December 31, 2023. Demographic, clinical, laboratory, and treatment outcome data were systematically collected. Multivariable logistic and Cox regression models identified independent predictors of advanced HIV disease, virological failure, and all-cause mortality. Median age was 34 years (range: 18–74), with male predominance (55.0%). Most patients were single (60.1%), unemployed (46.1%), and uninsured (83.6%); Sub-Saharan Africans comprised 19.9%. Heterosexual transmission predominated (72.0%), and symptoms prompted diagnosis in 58.9%. Tuberculosis was the leading opportunistic infection (35.1%), and 41.4% presented with CDC stage C. Median baseline CD4 was 186 cells/mm³, with 60.6% having CD4 < 200 cells/mm³. At 6 months, 75.0% achieved viral suppression, 10.0% experienced virological failure, and overall mortality was 8.3%. Independent mortality predictors ( n = 396) included CD4 < 200 cells/mm³ (aHR = 3.67; p < 0.001), age ≥ 40 years (aHR = 1.62; p = 0.003), tuberculosis (aHR = 2.56; p = 0.027), and higher baseline viral load (aHR = 1.18; p = 0.038). Advanced disease ( n = 236 with CD4 data) was associated with age ≥ 40 years, Sub-Saharan African origin, unemployment, divorced/widowed status, and tuberculosis. Virological failure at 6 months ( n = 280 with viral load data) was predicted by advanced HIV disease (aOR = 1.85; p = 0.034), higher baseline viral load (aOR = 1.92 per log₁₀; p < 0.001), and non-TDF/3TC/DTG regimens (aOR = 1.89; p = 0.021). This single-center study reveals alarming rates of late HIV diagnosis, substantial TB co-infection, and significant early mortality linked to advanced immunosuppression. While dolutegravir-based ART achieved 75% virological suppression at six months, socioeconomic vulnerabilities and delayed presentation remain major barriers. Targeted interventions including expanded community-based screening, integrated TB/HIV services, socioeconomic support, and enhanced screening for migrant populations are urgently needed. Multi-center validation with extended follow-up is warranted. Not applicable.