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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: rate ratio for a 10-year increase in age
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Figure 3: Adequate CD4+ cell count and HIV viral load monitoring in six countries in the WHO Region of the Americas, 2000–2011: rate ratio for a 10-year increase in age

Mentions: Factors associated with adequate CD4+ cell count and viral load monitoring at each site and across all sites combined were identified. At all sites, adequate CD4+ cell count and viral load monitoring was more likely in older participants (Fig. 3) and in those who started ART more recently (Fig. 4). Patients with a CD4+ cell count less than 200 cells/µL at ART initiation were more likely to have adequate monitoring than those with a count more than 350 cells/µL (Fig. 5). Participants whose first ART regimen contained a non-nucleoside reverse transcriptase inhibitor were also more likely to have adequate monitoring than those treated with other regimens (Fig. 6). Neither sex, a CD4+ cell count in the range 200 to 350 cells/µL nor prior AIDS-defining events influenced the likelihood of adequate CD4+ cell count and viral load monitoring.


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: rate ratio for a 10-year increase in age
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Adequate CD4+ cell count and HIV viral load monitoring in six countries in the WHO Region of the Americas, 2000–2011: rate ratio for a 10-year increase in age
Mentions: Factors associated with adequate CD4+ cell count and viral load monitoring at each site and across all sites combined were identified. At all sites, adequate CD4+ cell count and viral load monitoring was more likely in older participants (Fig. 3) and in those who started ART more recently (Fig. 4). Patients with a CD4+ cell count less than 200 cells/µL at ART initiation were more likely to have adequate monitoring than those with a count more than 350 cells/µL (Fig. 5). Participants whose first ART regimen contained a non-nucleoside reverse transcriptase inhibitor were also more likely to have adequate monitoring than those treated with other regimens (Fig. 6). Neither sex, a CD4+ cell count in the range 200 to 350 cells/µL nor prior AIDS-defining events influenced the likelihood of adequate CD4+ cell count and viral load monitoring.

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