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Virological failure and treatment switch after ART initiation among people living with HIV with and without routine viral load monitoring in Asia

Authors
 Sirinya Teeraananchai  ;  Matthew Law  ;  David Boettiger  ;  Nicole De La Mata  ;  Nikhil Gupte  ;  Yun-Ting Lawrence Chan  ;  Thach Ngoc Pham  ;  Romanee Chaiwarith  ;  Penh Sun Ly  ;  Yu-Jiun Chan  ;  Sasisopin Kiertiburanakul  ;  Suwimon Khusuwan  ;  Fujie Zhang  ;  Evy Yunihastuti  ;  Nagalingeswaran Kumarasamy  ;  Sanjay Pujari  ;  Iskandar Azwa  ;  I Ketut Agus Somia  ;  Junko Tanuma  ;  Rossana Ditangco  ;  Jun Yong Choi  ;  Oon Tek Ng  ;  Cuong Duy Do  ;  Yasmin Gani  ;  Jeremy Ross  ;  Awachana Jiamsakul 
Citation
 JOURNAL OF THE INTERNATIONAL AIDS SOCIETY, Vol.25(8) : e25989, 2022-08 
Journal Title
JOURNAL OF THE INTERNATIONAL AIDS SOCIETY
Issue Date
2022-08
MeSH
Adolescent ; Adult ; Anti-HIV Agents* ; Antiretroviral Therapy, Highly Active ; CD4 Lymphocyte Count ; Female ; HIV Infections* ; Humans ; Male ; Middle Aged ; Treatment Failure ; Viral Load
Keywords
Asia ; HIV ; antiretroviral therapy ; cohort studies ; routine viral load testing ; virological failure
Abstract
Introduction: Viral load (VL) testing is still challenging to monitor treatment responses of antiretroviral therapy (ART) for HIV treatment programme in Asia. We assessed the association between routine VL testing and virological failure (VF) and determine factors associated with switching to second-line regimen.

Methods: Among 21 sites from the TREAT Asia HIV Observational Database (TAHOD), people living with HIV (PLHIV) aged ≥18 years initiating ART from 2003 to 2021 were included. We calculated the average number of VL tests per patient per year between the date of ART initiation and the most recent visit. If the median average number of VL tests was ≥ 0.80 per patient per year, the site was classified as a routine VL site. A site with a median < 0.80 was classified into the non-routine VL sites. VF was defined as VL ≥1000 copies/ml during first-line therapy. Factors associated with VF were analysed using generalized estimating equations with Poisson distribution.

Results: Of 6277 PLHIV starting ART after 2003, 3030 (48%) were from 11 routine VL testing sites and 3247 (52%) were from 10 non-routine VL testing sites. The median follow-up was 9 years (IQR 5-13). The median age was 35 (30-42) years; 68% were male and 5729 (91%) started non-nucleoside reverse-transcriptase inhibitor-based regimen. The median pre-ART CD4 count in PLHIV from routine VL sites was lower compared to non-routine VL sites (144 vs. 156 cells/mm3 , p <0.001). Overall, 1021 subsequent VF at a rate of 2.15 (95% CI 2.02-2.29) per 100 person-years (PY). VF was more frequent at non-routine VL sites (adjusted incidence rate ratio 2.85 [95% CI 2.27-3.59]) compared to routine VL sites. Other factors associated with an increased rate of VF were age <50 years and CD4 count <350 cells/mm3 . A total of 817 (13%) patients switched to second-line regimen at a rate of 1.44 (95% CI 1.35-1.54) per 100 PY. PLHIV at routine VL monitoring sites were at higher risk of switching than those at non-routine VL sites (adjusted sub-hazard ratio 1.78 95% CI [1.17-2.71]).

Conclusions: PLHIV from non-routine VL sites had a higher incidence of persistent VF and a low switching regimen rate, reflecting possible under-utilized VL testing.
Files in This Item:
T202205059.pdf Download
DOI
10.1002/jia2.25989
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/191873
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