Allahna Esber1,2, Christina Polyak1,2, Francis Kiweewa3, Jonah Maswai4, John Owuoth5, Lucas Maganga6, Yakubu Adamu7, Patrick W Hickey8, Julie A Ake1, Trevor A Crowell1,2. 1. US Military Human Immunodeficiency Virus Research Program, Walter Reed Army Institute of Research, Silver Spring. 2. Henry M. Jackson Foundation (HJF) for the Advancement of Military Medicine, Bethesda, Maryland. 3. Makerere University-Walter Reed Project, Kampala, Uganda. 4. HJF Medical Research International, Kericho. 5. HJF Medical Research International, Kisumu, Kenya. 6. Mbeya Medical Research Centre, Tanzania. 7. US Army Medical Research Directorate-Africa/Nigeria, Abuja. 8. Department of Pediatrics, Uniformed Services University, Bethesda, Maryland.
Abstract
BACKGROUND: World Health Organization (WHO) guidelines identify human immunodeficiency virus (HIV) viral load <1000 copies/mL as the goal of antiretroviral therapy (ART). However, the clinical implications of viremia below this threshold are unclear in the African context. We examined factors associated with persistent low-level viremia (pLLV) and quantified the risk of subsequent virologic. METHODS: The African Cohort Study enrolled HIV-infected adults at clinics in Uganda, Kenya, Tanzania, and Nigeria, with assessments every 6 months. We evaluated participants prescribed ART for at least 6 months without virologic failure for pLLV. We used multinomial logistic regression to evaluate associations between prespecified factors of interest and 3 levels of pLLV (<200, 200-499, and 500-999 copies/mL). We used Anderson-Gill extended Cox proportional hazards to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for viremia category associations with time to failure. RESULTS: We included 1511 participants with 4382 person-years of follow-up. PLLV <200 copies/mL was observed at 20% of visits while 2% of visits had pLLV 200-499 and 500-999 copies/mL each, with substantial variation by site. Protease inhibitor-containing ART was associated with increased risk of pLLV. Compared to undetectable viral load, pLLV ≥200 copies/mL doubled the risk of developing virologic failure (pLLV 200-499: HR, 1.81 [95% CI, 1.08-3.02]); pLLV 500-999: HR, 2.36 [95% CI, 1.52-3.67]). CONCLUSIONS: Participants with pLLV ≥200 copies/mL were at increased risk of subsequent virologic failure. Optimized HIV care in this setting should target viral suppression <200 copies/mL.
BACKGROUND: World Health Organization (WHO) guidelines identify human immunodeficiency virus (HIV) viral load <1000 copies/mL as the goal of antiretroviral therapy (ART). However, the clinical implications of viremia below this threshold are unclear in the African context. We examined factors associated with persistent low-level viremia (pLLV) and quantified the risk of subsequent virologic. METHODS: The African Cohort Study enrolled HIV-infected adults at clinics in Uganda, Kenya, Tanzania, and Nigeria, with assessments every 6 months. We evaluated participants prescribed ART for at least 6 months without virologic failure for pLLV. We used multinomial logistic regression to evaluate associations between prespecified factors of interest and 3 levels of pLLV (<200, 200-499, and 500-999 copies/mL). We used Anderson-Gill extended Cox proportional hazards to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for viremia category associations with time to failure. RESULTS: We included 1511 participants with 4382 person-years of follow-up. PLLV <200 copies/mL was observed at 20% of visits while 2% of visits had pLLV 200-499 and 500-999 copies/mL each, with substantial variation by site. Protease inhibitor-containing ART was associated with increased risk of pLLV. Compared to undetectable viral load, pLLV ≥200 copies/mL doubled the risk of developing virologic failure (pLLV 200-499: HR, 1.81 [95% CI, 1.08-3.02]); pLLV 500-999: HR, 2.36 [95% CI, 1.52-3.67]). CONCLUSIONS:Participants with pLLV ≥200 copies/mL were at increased risk of subsequent virologic failure. Optimized HIV care in this setting should target viral suppression <200 copies/mL.
Authors: Tessa Concepcion; Jennifer Velloza; Christopher G Kemp; Amritha Bhat; Ian M Bennett; Deepa Rao; Christina S Polyak; Julie A Ake; Allahna Esber; Nicole Dear; Jonah Maswai; John Owuoth; Valentine Sing'oei; Emmanuel Bahemana; Michael Iroezindu; Hannah Kibuuka; Pamela Y Collins Journal: AIDS Behav Date: 2022-10-09
Authors: Domonique M Reed; Allahna L Esber; Trevor A Crowell; Kavitha Ganesan; Hannah Kibuuka; Jonah Maswai; John Owuoth; Emmanuel Bahemana; Michael Iroezindu; Julie A Ake; Christina S Polyak Journal: AIDS Res Ther Date: 2021-07-22 Impact factor: 2.250
Authors: Jonathan Z Li; Evgenia Aga; Ronald J Bosch; Mark Pilkinton; Eugène Kroon; Lynsay MacLaren; Michael Keefer; Lawrence Fox; Liz Barr; Edward Acosta; Jintanat Ananworanich; Robert Coombs; John W Mellors; Alan L Landay; Bernard Macatangay; Steven Deeks; Rajesh T Gandhi; Davey M Smith Journal: Clin Infect Dis Date: 2022-03-09 Impact factor: 20.999
Authors: Elizabeth H Lee; Kavitha Ganesan; Samoel A Khamadi; Stanley C Meribe; Dorothy Njeru; Yakubu Adamu; Fred Magala; Trevor A Crowell; Eniko Akom; Patricia Agaba; Priyanka Desai; Tiffany Hamm; Deydre Teyhen; Julie A Ake; Christina S Polyak; Douglas Shaffer; Fredrick Sawe; Patrick W Hickey Journal: Am J Trop Med Hyg Date: 2021-01 Impact factor: 3.707