BACKGROUND: Plasma viral load (pVL) is a key indicator of therapeutic response in HIV-infected patients receiving combination antiretroviral therapy (cART), but is often unavailable in routine clinical care in resource-limited settings. Previous model-based simulation studies have suggested that the benefits of routine pVL monitoring among patients on first-line regimens in resource-limited settings are modest, but this needs corroboration in well-defined study populations. METHODS: We investigated virological suppression levels and identified predictors of detectable viraemia among 870 randomly selected patients who started cART between May 2009 and April 2012 in 10 health-care facilities in Addis Ababa, Ethiopia. A total of 656 (75.4%) patients, who were alive, were retained in HIV care and receiving cART for at least 6 months provided a blood sample for pVL measurement. Predictors of detectable viraemia were identified in a multivariate logistic regression model. RESULTS: In on-treatment analysis, 94.5% (95% CI 92.5, 96.1) of the patients achieved virological suppression below 400 copies/ml after a median (IQR) of 26 (17-35) months on cART. When patients who were lost to follow-up, dead or stopped were assumed to have had detectable viraemia, the proportion of patients with virological suppression <400 copies/ml decreased to 74.6% (95% CI 71.5%, 77.4%). Younger age, lower educational status, <95% medication adherence, lower CD4(+) T-cell count at cART initiation and/or the diagnosis of immunological failure thereafter significantly predicted detectable viraemia. CONCLUSIONS: Virological suppression levels can be high in an established ART programme in a resource-limited setting, even without the availability of routine pVL monitoring. Efforts to improve treatment outcomes should focus on younger and illiterate patients, earlier detection of HIV-positive status and cART initiation before patients are severely immunocompromised, and improving retention in care.
BACKGROUND: Plasma viral load (pVL) is a key indicator of therapeutic response in HIV-infectedpatients receiving combination antiretroviral therapy (cART), but is often unavailable in routine clinical care in resource-limited settings. Previous model-based simulation studies have suggested that the benefits of routine pVL monitoring among patients on first-line regimens in resource-limited settings are modest, but this needs corroboration in well-defined study populations. METHODS: We investigated virological suppression levels and identified predictors of detectable viraemia among 870 randomly selected patients who started cART between May 2009 and April 2012 in 10 health-care facilities in Addis Ababa, Ethiopia. A total of 656 (75.4%) patients, who were alive, were retained in HIV care and receiving cART for at least 6 months provided a blood sample for pVL measurement. Predictors of detectable viraemia were identified in a multivariate logistic regression model. RESULTS: In on-treatment analysis, 94.5% (95% CI 92.5, 96.1) of the patients achieved virological suppression below 400 copies/ml after a median (IQR) of 26 (17-35) months on cART. When patients who were lost to follow-up, dead or stopped were assumed to have had detectable viraemia, the proportion of patients with virological suppression <400 copies/ml decreased to 74.6% (95% CI 71.5%, 77.4%). Younger age, lower educational status, <95% medication adherence, lower CD4(+) T-cell count at cART initiation and/or the diagnosis of immunological failure thereafter significantly predicted detectable viraemia. CONCLUSIONS: Virological suppression levels can be high in an established ART programme in a resource-limited setting, even without the availability of routine pVL monitoring. Efforts to improve treatment outcomes should focus on younger and illiterate patients, earlier detection of HIV-positive status and cART initiation before patients are severely immunocompromised, and improving retention in care.
Authors: Awachana Jiamsakul; Azar Kariminia; Keri N Althoff; Carina Cesar; Claudia P Cortes; Mary-Ann Davies; Viet Chau Do; Brian Eley; John Gill; Nagalingeswaran Kumarasamy; Daisy Maria Machado; Richard Moore; Hans Prozesky; Elizabeth Zaniewski; Matthew Law Journal: J Acquir Immune Defic Syndr Date: 2017-11-01 Impact factor: 3.731
Authors: Andreas D Haas; Elizabeth Radin; Avi J Hakim; Andreas Jahn; Neena M Philip; Sasi Jonnalagadda; Suzue Saito; Andrea Low; Hetal Patel; Amee M Schwitters; John H Rogers; Koen Frederix; Evelyn Kim; George Bello; Daniel B Williams; Bharat Parekh; Karampreet Sachathep; Danielle T Barradas; Thokozani Kalua; Sehin Birhanu; Godfrey Musuka; Owen Mugurungi; Beth A Tippett Barr; Katrina Sleeman; Lloyd B Mulenga; Kyaw Thin; Trong T Ao; Kristin Brown; Andrew C Voetsch; Jessica E Justman Journal: J Int AIDS Soc Date: 2020-11 Impact factor: 5.396
Authors: Ali Ahmed; Muhammad Saqlain; Naila Bashir; Juman Dujaili; Furqan Hashmi; Faizan Mazhar; Amjad Khan; Musarat Jabeen; Ali Blebil; Ahmed Awaisu Journal: Qual Life Res Date: 2021-02-13 Impact factor: 4.147
Authors: Maria F Nardell; Oluwatomi Adeoti; Carson Peters; Bernard Kakuhikire; Caroline Govathson-Mandimika; Lawrence Long; Sophie Pascoe; Alexander C Tsai; Ingrid T Katz Journal: J Int AIDS Soc Date: 2022-03 Impact factor: 5.396