Comprehensive Analysis of HIV Epidemiology, Transmission, and Immunological Characteristics in the Syrian Arab Republic (SAR)

Background: This study explores the dynamics of HIV in the Syrian Arab Republic, with a focus on long-term epidemiological trends and recent developments (2018–2020). It examines incidence, transmission pathways, testing outcomes, mortality rates, and immunological characteristics to provide insights into the evolving epidemic within the context of ongoing national challenges.Methods: A descriptive and analytical epidemiological design was employed using national surveillance records, testing center data, and clinical monitoring systems. Analyses covered historical data (1987–2014) and detailed demographic, clinical, and treatment outcomes from 2018–2020.Results: Reported HIV cases increased steadily until peaks in 2006 and 2009, followed by a sharp decline after 2010, coinciding with reduced testing during the crisis and suggesting underreporting. From 2018 to 2020, most cases occurred in adults ≥25 years, with minimal incidence among younger groups. Heterosexual contact was the primary transmission route; homosexual contact and injecting drug use were reported only among men, while blood transfusion and mother-to-child transmission occurred at similarly low rates in both sexes. Mortality declined markedly by 2020 but remained higher among males. Immunological assessment showed low CD4 counts and an inverted CD4/CD8 ratio. First-line ART regimens, particularly TDF+FTC+EFV, were most frequently prescribed, though treatment interruption and mortality were highest with AZT+3TC+NVP.Conclusion: Findings highlight the impact of conflict on HIV surveillance and care in Syria. Strong prevention strategies rely on dependable monitoring, and sustained ART access, particularly for high-risk groups, remains critical to reducing transmission and mortality.Keywords:HIV, Epidemiology, Transmission, Syrian Arab Republic (SAR), Incidence, Antiretroviral therapy