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Monitoring of HIV treatment in seven countries in the WHO Region of the Americas.

Belaunzarán-Zamudio PF, Caro-Vega YN, Shepherd BE, Crabtree-Ramírez BE, Luz PM, Grinsztejn B, Cesar C, Cahn P, Cortés C, Wolff M, Pape JW, Padgett D, Gotuzzo E, McGowan C, Sierra-Madero JG, CCASAn - Bull. World Health Organ. (2015)

Bottom Line: Factors associated with adequate monitoring were analysed using regression methods.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Clínica de Inmuno-Infectología, Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Calle Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, México Distrito Federal, CP 14080, Mexico .

ABSTRACT

Objective: To determine the prevalence of adequate monitoring and the costs of measuring CD4+ T-lymphocytes (CD4+ cell) and human immunodeficiency virus (HIV) viral load in people receiving antiretroviral therapy (ART) in seven countries in the WHO Region of the Americas.

Methods: We obtained retrospective, longitudinal data for 14 476 adults who started a first ART regimen at seven HIV clinics in Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru between 2000 and 2011. We estimated the proportion of 180-day periods with adequate monitoring, which we defined as at least one CD4+ cell count and one viral load measurement. Factors associated with adequate monitoring were analysed using regression methods. The costs of the tests were estimated.

Findings: The median follow-up time was 50.4 months; the proportion of 180-day periods with adequate CD4+ cell counts was 69% while the proportion with adequate monitoring was 62%. Adequate monitoring was more likely in participants who were older, who started ART more recently, whose first regimen included a non-nucleoside reverse transcriptase inhibitor or who had a CD4+ cell count less than 200 cells/µl at ART initiation. The cost of one CD4+ cell count ranged from 7.37 United States dollars (US$) in Argentina to US$ 64.09 in Chile; the cost of one viral load measurement ranged from US$ 20.34 in Brazil to US$ 186.28 in Haiti.

Conclusion: In HIV-infected participants receiving ART in the WHO Region of the Americas, CD4+ cell count and viral load monitoring was often carried out less frequently than regional guidelines recommend. The laboratory costs of monitoring varied greatly.

No MeSH data available.


Related in: MedlinePlus

Adequate CD4+ cell count and HIV viral load monitoring in six countries in the WHO Region of the Americas, 2000–2011
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Figure 1: Adequate CD4+ cell count and HIV viral load monitoring in six countries in the WHO Region of the Americas, 2000–2011

Mentions: The adequacy of CD4+ cell count and viral load monitoring is shown for each site in Fig. 1. The proportion of periods with adequate monitoring was highest in Mexico (86%) and Argentina (80%) but much lower in Honduras (26%). Across the six sites for which data were available, the proportion of periods with adequate CD4+ cell count and viral load monitoring was 62% (95% confidence interval, CI: 52–73) – the large confidence interval was due to the substantial variation between sites. Fig. 2 shows the proportion of 180-day periods with adequate CD4+ cell count monitoring alone. Overall, the proportions were higher than those observed for CD4+ cell count and viral load monitoring combined and ranged from 86% and 81% in Mexico and Argentina, respectively, to 54% and 48% in Honduras and Haiti, respectively. Across all seven sites, the proportion of periods with adequate CD4+ cell count monitoring alone was 69% (95% CI: 57–82). General trends were similar in sensitivity analyses that included periods of less than 180 days (data available from corresponding author).


Monitoring of HIV treatment in seven countries in the WHO Region of the Americas.

Belaunzarán-Zamudio PF, Caro-Vega YN, Shepherd BE, Crabtree-Ramírez BE, Luz PM, Grinsztejn B, Cesar C, Cahn P, Cortés C, Wolff M, Pape JW, Padgett D, Gotuzzo E, McGowan C, Sierra-Madero JG, CCASAn - Bull. World Health Organ. (2015)

Adequate CD4+ cell count and HIV viral load monitoring in six countries in the WHO Region of the Americas, 2000–2011
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4581655&req=5

Figure 1: Adequate CD4+ cell count and HIV viral load monitoring in six countries in the WHO Region of the Americas, 2000–2011
Mentions: The adequacy of CD4+ cell count and viral load monitoring is shown for each site in Fig. 1. The proportion of periods with adequate monitoring was highest in Mexico (86%) and Argentina (80%) but much lower in Honduras (26%). Across the six sites for which data were available, the proportion of periods with adequate CD4+ cell count and viral load monitoring was 62% (95% confidence interval, CI: 52–73) – the large confidence interval was due to the substantial variation between sites. Fig. 2 shows the proportion of 180-day periods with adequate CD4+ cell count monitoring alone. Overall, the proportions were higher than those observed for CD4+ cell count and viral load monitoring combined and ranged from 86% and 81% in Mexico and Argentina, respectively, to 54% and 48% in Honduras and Haiti, respectively. Across all seven sites, the proportion of periods with adequate CD4+ cell count monitoring alone was 69% (95% CI: 57–82). General trends were similar in sensitivity analyses that included periods of less than 180 days (data available from corresponding author).

Bottom Line: Factors associated with adequate monitoring were analysed using regression methods.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Clínica de Inmuno-Infectología, Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Calle Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, México Distrito Federal, CP 14080, Mexico .

ABSTRACT

Objective: To determine the prevalence of adequate monitoring and the costs of measuring CD4+ T-lymphocytes (CD4+ cell) and human immunodeficiency virus (HIV) viral load in people receiving antiretroviral therapy (ART) in seven countries in the WHO Region of the Americas.

Methods: We obtained retrospective, longitudinal data for 14 476 adults who started a first ART regimen at seven HIV clinics in Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru between 2000 and 2011. We estimated the proportion of 180-day periods with adequate monitoring, which we defined as at least one CD4+ cell count and one viral load measurement. Factors associated with adequate monitoring were analysed using regression methods. The costs of the tests were estimated.

Findings: The median follow-up time was 50.4 months; the proportion of 180-day periods with adequate CD4+ cell counts was 69% while the proportion with adequate monitoring was 62%. Adequate monitoring was more likely in participants who were older, who started ART more recently, whose first regimen included a non-nucleoside reverse transcriptase inhibitor or who had a CD4+ cell count less than 200 cells/µl at ART initiation. The cost of one CD4+ cell count ranged from 7.37 United States dollars (US$) in Argentina to US$ 64.09 in Chile; the cost of one viral load measurement ranged from US$ 20.34 in Brazil to US$ 186.28 in Haiti.

Conclusion: In HIV-infected participants receiving ART in the WHO Region of the Americas, CD4+ cell count and viral load monitoring was often carried out less frequently than regional guidelines recommend. The laboratory costs of monitoring varied greatly.

No MeSH data available.


Related in: MedlinePlus