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Superior virologic and treatment outcomes when viral load is measured at 3 months compared to 6 months on antiretroviral therapy.

Kerschberger B, Boulle AM, Kranzer K, Hilderbrand K, Schomaker M, Coetzee D, Goemaere E, Van Cutsem G - J Int AIDS Soc (2015)

Bottom Line: Patients in the VL3M group had a 22% risk reduction of virologic failure (aHR 0.78, 95% CI 0.64-0.95; p=0.016) and a 27% risk reduction of switch to second-line ART (aHR 0.73, 95% CI 0.58-0.92; p=0.008) when compared to patients in the VL6M group.For each additional month of delay of the first VL measurement (up to nine months), the risk of virologic failure increased by 9% (aHR 1.09, 95% CI 1.02-1.15; p=0.008) and switch to second-line ART by 13% (aHR 1.13, 95% CI 1.05-1.21; p<0.001).ART programmes should consider the first VL measurement at three months after ART initiation.

View Article: PubMed Central - PubMed

Affiliation: Médecins sans Frontières, Khayelitsha, Cape Town, South Africa; benadi11@yahoo.de.

ABSTRACT

Introduction: Routine viral load (VL) monitoring is utilized to assess antiretroviral therapy (ART) adherence and virologic failure, and it is currently scaled-up in many resource-constrained settings. The first routine VL is recommended as late as six months after ART initiation for early detection of sub-optimal adherence. We aimed to assess the optimal timing of first VL measurement after initiation of ART.

Methods: This was a retrospective, cohort analysis of routine monitoring data of adults enrolled at three primary care clinics in Khayelitsha, Cape Town, between January 2002 and March 2009. Primary outcomes were virologic failure and switch to second-line ART comparing patients in whom first VL done was at three months (VL3M) and six months (VL6M) after ART initiation. Adjusted hazard ratios (aHR) were estimated using Cox proportional hazard models.

Results: In total, 6264 patients were included for the time to virologic failure and 6269 for the time to switch to second-line ART analysis. Patients in the VL3M group had a 22% risk reduction of virologic failure (aHR 0.78, 95% CI 0.64-0.95; p=0.016) and a 27% risk reduction of switch to second-line ART (aHR 0.73, 95% CI 0.58-0.92; p=0.008) when compared to patients in the VL6M group. For each additional month of delay of the first VL measurement (up to nine months), the risk of virologic failure increased by 9% (aHR 1.09, 95% CI 1.02-1.15; p=0.008) and switch to second-line ART by 13% (aHR 1.13, 95% CI 1.05-1.21; p<0.001).

Conclusions: A first VL at three months rather than six months with targeted adherence interventions for patients with high VL may improve long-term virologic suppression and reduce switches to costly second-line ART. ART programmes should consider the first VL measurement at three months after ART initiation.

No MeSH data available.


Related in: MedlinePlus

Flow chart of patients eligible for baseline and regression analyses who initiated ART in three community health centres in Khayelitsha, Cape Town, from 1 January 2002 to 31 March 2009. *One patient with missing information on WHO staging also had missing information on CD4.
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Figure 0001: Flow chart of patients eligible for baseline and regression analyses who initiated ART in three community health centres in Khayelitsha, Cape Town, from 1 January 2002 to 31 March 2009. *One patient with missing information on WHO staging also had missing information on CD4.

Mentions: The median follow-up (starting from nine months after ART initiation) was 2.1 (IQR 0.8–3.4) and 2.2 (IQR 0.9–3.4) years for time to virologic failure and switch to second-line ART, respectively. During the follow-up period, 624 (9.1%) patients had recorded virologic failure and 479 (7.0%) were switched to second-line ART. The crude rates of virologic failure and switch to second-line ART during the study period were 4.1 (95% CI 3.8–4.4) and 3.0 (95% CI 2.8–3.3) per 100 person-years. Due to missing information on baseline CD4, 577 (8.4%) and 579 (8.5%) observations were omitted for time to virologic failure and switch to second-line ART, leaving 6264 and 6269 patients for multivariate analysis. Figure 1 shows a detailed description of patient outcomes and follow-up time for each VL group. The VL3M group included less study participants but median and total follow-up time was longer when compared to VL6M group.


Superior virologic and treatment outcomes when viral load is measured at 3 months compared to 6 months on antiretroviral therapy.

Kerschberger B, Boulle AM, Kranzer K, Hilderbrand K, Schomaker M, Coetzee D, Goemaere E, Van Cutsem G - J Int AIDS Soc (2015)

Flow chart of patients eligible for baseline and regression analyses who initiated ART in three community health centres in Khayelitsha, Cape Town, from 1 January 2002 to 31 March 2009. *One patient with missing information on WHO staging also had missing information on CD4.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4582072&req=5

Figure 0001: Flow chart of patients eligible for baseline and regression analyses who initiated ART in three community health centres in Khayelitsha, Cape Town, from 1 January 2002 to 31 March 2009. *One patient with missing information on WHO staging also had missing information on CD4.
Mentions: The median follow-up (starting from nine months after ART initiation) was 2.1 (IQR 0.8–3.4) and 2.2 (IQR 0.9–3.4) years for time to virologic failure and switch to second-line ART, respectively. During the follow-up period, 624 (9.1%) patients had recorded virologic failure and 479 (7.0%) were switched to second-line ART. The crude rates of virologic failure and switch to second-line ART during the study period were 4.1 (95% CI 3.8–4.4) and 3.0 (95% CI 2.8–3.3) per 100 person-years. Due to missing information on baseline CD4, 577 (8.4%) and 579 (8.5%) observations were omitted for time to virologic failure and switch to second-line ART, leaving 6264 and 6269 patients for multivariate analysis. Figure 1 shows a detailed description of patient outcomes and follow-up time for each VL group. The VL3M group included less study participants but median and total follow-up time was longer when compared to VL6M group.

Bottom Line: Patients in the VL3M group had a 22% risk reduction of virologic failure (aHR 0.78, 95% CI 0.64-0.95; p=0.016) and a 27% risk reduction of switch to second-line ART (aHR 0.73, 95% CI 0.58-0.92; p=0.008) when compared to patients in the VL6M group.For each additional month of delay of the first VL measurement (up to nine months), the risk of virologic failure increased by 9% (aHR 1.09, 95% CI 1.02-1.15; p=0.008) and switch to second-line ART by 13% (aHR 1.13, 95% CI 1.05-1.21; p<0.001).ART programmes should consider the first VL measurement at three months after ART initiation.

View Article: PubMed Central - PubMed

Affiliation: Médecins sans Frontières, Khayelitsha, Cape Town, South Africa; benadi11@yahoo.de.

ABSTRACT

Introduction: Routine viral load (VL) monitoring is utilized to assess antiretroviral therapy (ART) adherence and virologic failure, and it is currently scaled-up in many resource-constrained settings. The first routine VL is recommended as late as six months after ART initiation for early detection of sub-optimal adherence. We aimed to assess the optimal timing of first VL measurement after initiation of ART.

Methods: This was a retrospective, cohort analysis of routine monitoring data of adults enrolled at three primary care clinics in Khayelitsha, Cape Town, between January 2002 and March 2009. Primary outcomes were virologic failure and switch to second-line ART comparing patients in whom first VL done was at three months (VL3M) and six months (VL6M) after ART initiation. Adjusted hazard ratios (aHR) were estimated using Cox proportional hazard models.

Results: In total, 6264 patients were included for the time to virologic failure and 6269 for the time to switch to second-line ART analysis. Patients in the VL3M group had a 22% risk reduction of virologic failure (aHR 0.78, 95% CI 0.64-0.95; p=0.016) and a 27% risk reduction of switch to second-line ART (aHR 0.73, 95% CI 0.58-0.92; p=0.008) when compared to patients in the VL6M group. For each additional month of delay of the first VL measurement (up to nine months), the risk of virologic failure increased by 9% (aHR 1.09, 95% CI 1.02-1.15; p=0.008) and switch to second-line ART by 13% (aHR 1.13, 95% CI 1.05-1.21; p<0.001).

Conclusions: A first VL at three months rather than six months with targeted adherence interventions for patients with high VL may improve long-term virologic suppression and reduce switches to costly second-line ART. ART programmes should consider the first VL measurement at three months after ART initiation.

No MeSH data available.


Related in: MedlinePlus