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Study of the Factors that Influence Low-Level Viremias in Human Immunodeficiency Virus Patients in a Tertiary Hospital. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021. [DOI: 10.1097/ipc.0000000000001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mwangi A, van Wyk B. Factors Associated with Viral Suppression Among Adolescents on Antiretroviral Therapy in Homa Bay County, Kenya: A Retrospective Cross-Sectional Study. HIV AIDS (Auckl) 2021; 13:1111-1118. [PMID: 34992469 PMCID: PMC8713714 DOI: 10.2147/hiv.s345731] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/01/2021] [Indexed: 12/03/2022] Open
Abstract
Background Despite the success in initiating adolescents living with HIV on antiretroviral therapy (ART), questions remain about factors affecting viral suppression. In Kenya, only 63% of adolescents (aged 10–19 years) on ART had achieved viral suppression in 2016. We investigated factors associated with viral suppression among adolescents initiated on ART before November 30, 2017 in Homa Bay County, Kenya. Methods A retrospective cross-sectional analysis of 908 adolescents registered on ART for at least 6 months and with at least one documented viral load in the last 12 months, in six health facilities in Homa Bay County was conducted. Data were extracted from the electronic medical records and exported into an excel spreadsheet. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated with viral suppression and adjust for confounding, using Stata 12.0. Results Out of all participants, 80% (726) had achieved viral suppression (<1,000 copies of viral RNA/mL of blood at latest viral load count). After adjusting for other covariates, adolescents with good adherence to ART (AOR=2.3, 95% CI=1.38–3.84) and a most recent CD4 count of above 500 cells/mm3 (AOR=1.87, 95% CI=1.13–3.08), were more likely to be virally suppressed. Adolescents on second line ART treatment (AOR=0.45, 95% CI=0.28–0.73) and having inadequate adherence to ART (AOR=0.26, 95% CI=0.11–63) were less likely to be virally suppressed. Conclusion Viral suppression for adolescents on ART in this study is significantly higher than the national prevalence in 2016 (80% vs 63%), but it is still below the WHO target of 90%. Enhanced adherence support for adolescents on ART should be implemented to improve long-term adherence. Specific interventions are needed to “rescue” adolescents on second-line ART regimens who may have a history of poor adherence.
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Affiliation(s)
- Anne Mwangi
- School of Public Health, University of the Western Cape, Bellville, Western Cape Province, South Africa
| | - Brian van Wyk
- School of Public Health, University of the Western Cape, Bellville, Western Cape Province, South Africa
- Correspondence: Brian van Wyk Tel +27 82 8049055 Email
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Wakooko P, Gavamukulya Y, Wandabwa JN. Viral load Suppression and Associated Factors among HIV Patients on Antiretroviral Treatment in Bulambuli District, Eastern Uganda: A Retrospective Cohort Study. Infect Dis (Lond) 2020; 13:1178633720970632. [PMID: 33223836 PMCID: PMC7656881 DOI: 10.1177/1178633720970632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND HIV viral load suppression (VLS) is the most important indicator of successful antiretroviral therapy. In 2016, Bulambuli District started monitoring HIV patients on ART using viral load tests in an effort to meet the third 90 of the UNAIDS 90-90-90 strategy which is VLS. The objective of this study was to determine the progress in Bulambuli District towards achievement of VLS among HIV infected patients on ART and associated factors that affect this programme. METHODS A retrospective cohort study design was used. One thousand, one hundred and one medical records of HIV infected patients on ART who attended HIV clinic at Muyembe Health Centre IV from June 2016 to April 2018 were reviewed. A data abstraction tool was used for data collection. Chi Square was used to determine factors associated with VLS and logistic regression was used to determine the magnitude by which the ART and clinical factors influence VLS. Data were summarized using descriptive statistics for categorical variables and by computing proportions, means and standard deviation for continuous variables. RESULTS Of the patients (n = 944, 85.7%) had attained VLS. Adjusting for known confounders, only adherence to ART was a significant predictor of VLS. Individuals with fair adherence (80%-95%) had 2.667 times the odds of VLS, CI = 1.122-9.370, P-value of <.002 compared to individuals with good (>95%) adherence which was used as the reference while those with poor (<80%) adherence had 4.553 times the odds of attaining VLS, CI = 1.31-13.930, P-value of <.001 compared to individuals with good adherence. CONCLUSION These findings suggest that Bulambuli District, at 85.7% VLS is on track to attaining the third 90 of the 90, 90, 90 global targets by 2020. It further reveals that adherence is the only significant predictor of VLS in the District.
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Affiliation(s)
- Paul Wakooko
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
- Sironko District Local Government, Eastern Uganda
| | - Yahaya Gavamukulya
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Julius N Wandabwa
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
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Fentie Wendie T, Workneh BD. Prevalence and Predictors of Virological Failure Among Adults Living with HIV in South Wollo Zone, Northeast Ethiopia: A Retrospective Cohort Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:393-402. [PMID: 33061655 PMCID: PMC7519846 DOI: 10.2147/hiv.s266460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/14/2020] [Indexed: 11/27/2022]
Abstract
Background Highly active antiretroviral therapy has dramatically altered progression of HIV infection and significantly improved patients’ quality of life. However, drug resistance with consequent treatment failure raises the need for much more expensive and toxic second-line regimens. Thus, this study aimed at investigating the predictors of virologic failure among adults in Northeast Ethiopia. Methods A retrospective cohort study was carried out among adults who started first-line antiretroviral treatment from September 2005 to January 2018. Data were collected from patients’ medical records, entered and validated using EpiData version 3.1 and then exported to SPSS version 20 for analysis. Binary logistic regression was carried out; odds ratio with 95% CI was used to identify covariates associated with virologic failure. Statistical significance was considered at p-value <0.05. Results A total of 384 patients with mean age of 35.73±9.44 years were consecutively enrolled; of which, 213 (55.5%) were females, 255 (66.4%) had WHO clinical stage III/IV, and 130 (33.9%) had baseline CD4 count <100 cells/mm3. Mean baseline CD4 count was 179 cells/mm3 (range: 2–853 cells), and 158 (41.1%) participants were on AZT/3TC/NVP. Virological failure was diagnosed among 61 (15.9%) patients. The mean time to virologic failure after initiation of ART was 63.80 months (range: 17–150 months). After adjusting for other confounders, risk of experiencing virologic failure was significantly associated with being divorced (AOR 3.40, 95% CI 1.20–9.59), being naïve to ART (AOR 2.55, 95% CI 1.23–5.28), low (<100) baseline CD4 count (AOR 2.39, 95% CI 1.03–5.54) and nonadherence (AOR 6.73, 95% CI 3.29–13.76). Conclusion In this study, the prevalence of antiretroviral treatment failure was 15.9%. Being divorced, being naïve to antiretroviral therapy, low (<100 cells/mm3) baseline CD4 count and nonadherence were found to be significant predictors of virologic failure. ART programs should focus on early HIV diagnosis and ART initiation as well as enhanced adherence support.
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Affiliation(s)
| | - Birhanu Demeke Workneh
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Hussen S, Mama M, Mekonnen B, Yihune M, Shegaze M, Boti N, Shure M. Predictors of Time to Viral Load Suppression of Adult PLWHIV on ART in Arba Minch General Hospital: A Follow up Study. Ethiop J Health Sci 2019; 29:751-758. [PMID: 31741646 PMCID: PMC6842721 DOI: 10.4314/ejhs.v29i6.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/17/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Access to antiretroviral drugs for all infected persons in need is a global health priority. The viral load and CD4 counts should be monitored regularly. The plasma viral load should be reduced by as much and for as short as possible. Identifying factors that predict time to viral load suppression of patients on antiretroviral therapy regimens is thus vital to optimizing therapeutic success. Therefore, this study aimed to estimate the time to viral load suppression and identify predictors of time to viral load suppression of patients on antiretroviral therapy at Arba Minch general Hospital. METHODS This study was observational study using data abstracted from medical records, patient interviews and laboratory work-up during 6 months of follow up. The data were collected from 152 naive to anti-retro viral drug patients. The univariable and multivariable Cox proportional hazard regression analyses were done to identify predictors. RESULT The median survival time of viral load suppression among adult patients living with HIV was 3 months with 95% CI (2.68, 3.32). The Cox-proportional hazard analysis shows baseline CD4 count of <200cells/mm3 (AHR=0.683, CI:0.471, 0.990), baseline viral load of <10,000 copies/ml (AHR=4.135, CI:1.835, 9.317), having baseline Cotrimoxazole preventive therapy (AHR=1.997, CI:1.108, 3.600), having baseline Isoniazid preventive therapy (AHR=3.085, CI:1.721, 5.529) and good adherence level to ART (AHR=2.648, CI: 1.202, 5.834) significantly predict the time to viral load suppression. CONCLUSION Early improvement and maintenance of CD4 count and viral load to normal level should be attained through streamlining and strengthening monitoring and counseling of patients on adherence to ART, Cotrimoxazole and Isoniazid drugs.
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Affiliation(s)
- Sultan Hussen
- Arba Minch University, College of Medicine & Health Sciences, Department of Public Health, Arba Minch, Ethiopia
| | - Mohammedaman Mama
- Madda-Walabu University, College of Medicine & Health Sciences, Department of Laboratory, Bale Goba, Ethiopia
| | - Bitew Mekonnen
- Arba Minch University, College of Medicine & Health Sciences, Department of Nursing, Arba Minch, Ethiopia
| | - Manaye Yihune
- Arba Minch University, College of Medicine & Health Sciences, Department of Public Health, Arba Minch, Ethiopia
| | - Mulugeta Shegaze
- Arba Minch University, College of Medicine & Health Sciences, Department of Public Health, Arba Minch, Ethiopia
| | - Negussie Boti
- Arba Minch University, College of Medicine & Health Sciences, Department of Public Health, Arba Minch, Ethiopia
| | - Mohammed Shure
- Arba Minch University, College of Social Sciences and Humanities, Department of English Language and Literature, Arba Minch, Ethiopia
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Kiweewa F, Esber A, Musingye E, Reed D, Crowell TA, Cham F, Semwogerere M, Namagembe R, Nambuya A, Kafeero C, Tindikahwa A, Eller LA, Millard M, Gelderblom HC, Keshinro B, Adamu Y, Maswai J, Owuoth J, Sing’oei VC, Maganga L, Bahemana E, Khamadi S, Robb ML, Ake JA, Polyak CS, Kibuuka H. HIV virologic failure and its predictors among HIV-infected adults on antiretroviral therapy in the African Cohort Study. PLoS One 2019; 14:e0211344. [PMID: 30721233 PMCID: PMC6363169 DOI: 10.1371/journal.pone.0211344] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/12/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The 2016 WHO consolidated guidelines on the use of antiretroviral drugs defines HIV virologic failure for low and middle income countries (LMIC) as plasma HIV-RNA ≥ 1000 copies/mL. We evaluated virologic failure and predictors in four African countries. MATERIALS AND METHODS We included HIV-infected participants on a WHO recommended antiretroviral therapy (ART) regimen and enrolled in the African Cohort Study between January 2013 and October 2017. Studied outcomes were virologic failure (plasma HIV-RNA ≥ 1000 copies/mL at the most recent visit), viraemia (plasma HIV-RNA ≥ 50 copies/mL at the most recent visit); and persistent viraemia (plasma HIV-RNA ≥ 50 copies/mL at two consecutive visits). Generalized linear models were used to estimate relative risks with their 95% confidence intervals. RESULTS 2054 participants were included in this analysis. Viraemia, persistent viraemia and virologic failure were observed in 396 (19.3%), 160 (7.8%) and 184 (9%) participants respectively. Of the participants with persistent viraemia, only 57.5% (92/160) had confirmed virologic failure. In the multivariate analysis, attending clinical care site other than the Uganda sitebeing on 2nd line ART (aRR 1.8, 95% CI 1·28-2·66); other ART combinations not first line and not second line (aRR 3.8, 95% CI 1.18-11.9), a history of fever in the past week (aRR 3.7, 95% CI 1.69-8.05), low CD4 count (aRR 6.9, 95% CI 4.7-10.2) and missing any day of ART (aRR 1·8, 95% CI 1·27-2.57) increased the risk of virologic failure. Being on 2nd line therapy, the site where one receives care and CD4 count < 500 predicted viraemia, persistent viraemia and virologic failure. CONCLUSION In conclusion, these findings demonstrate that HIV-infected patients established on ART for more than six months in the African setting frequently experienced viraemia while continuing to be on ART. The findings also show that being on second line, low CD4 count, missing any day of ART and history of fever in the past week remain important predictors of virologic failure that should trigger intensified adherence counselling especially in the absence of reliable or readily available viral load monitoring. Finally, clinical care sites are different calling for further analyses to elucidate on the unique features of these sites.
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Affiliation(s)
- Francis Kiweewa
- Makerere University- Walter Reed Project, Kampala, Uganda
- * E-mail:
| | - Allahna Esber
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States of America
| | - Ezra Musingye
- Makerere University- Walter Reed Project, Kampala, Uganda
| | - Domonique Reed
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States of America
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States of America
| | - Fatim Cham
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States of America
| | | | | | - Alice Nambuya
- Makerere University- Walter Reed Project, Kampala, Uganda
| | - Cate Kafeero
- Makerere University- Walter Reed Project, Kampala, Uganda
| | | | - Leigh Anne Eller
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States of America
| | - Monica Millard
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Huub C. Gelderblom
- International AIDS Vaccine Initiative, New York, New York, United States of America
| | | | - Yakubu Adamu
- HJF Medical Research International, Abuja, Nigeria
| | - Jonah Maswai
- HJF Medical Research International, Kericho, Kenya
| | - John Owuoth
- HJF Medical Research International, Kisumu, Kenya
| | | | | | | | | | - Merlin L. Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States of America
| | - Julie A. Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Christina S. Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States of America
| | - Hannah Kibuuka
- Makerere University- Walter Reed Project, Kampala, Uganda
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Le NK, Riggi E, Marrone G, Vu TV, Izurieta RO, Nguyen CKT, Larsson M, Do CD. Assessment of WHO criteria for identifying ART treatment failure in Vietnam from 2007 to 2011. PLoS One 2017; 12:e0182688. [PMID: 28877173 PMCID: PMC5587312 DOI: 10.1371/journal.pone.0182688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/20/2017] [Indexed: 11/19/2022] Open
Abstract
Objective We evaluated the sensitivity and specificity of the WHO immunological criteria for detecting antiretroviral therapy (ART) treatment failure in a cohort of Vietnamese patients. We conducted a stratified analysis to determine the effects of BMI, peer support, adherence to antiretroviral (ARV) drugs, age, and gender on the sensitivity and specificity of the WHO criteria. Methods We conducted a retrospective cohort study of 605 HIV-infected patients using data previously collected from a cluster randomized control trial study. We compared the sensitivity and specificity of CD4+ counts to the gold standard of virologic testing as a diagnostic test for ART failure at different time points of 12, 18, and 24 months. Results The sensitivity [95% confidence interval (CI)] of the WHO immunological criteria based on a viral load ≥ 1000 copies/mL was 12% (5%-23%), 14% (2%-43%), and 12.5% (2%-38%) at 12, 18, and 24 months, respectively. In the same order, the specificity was 93% (90%-96%), 98% (96%-99%), and 98% (96%-100%). The positive predictive values (PPV) at 12, 18, and 24 months were 22% (9%-40%), 20% (3%-56%), and 29% (4%-71%); the negative predictive values (NPV) at the same time points were 87% (84%-90%), 97% (95%-98%), and 96% (93%-98%). The stratified analysis revealed similar sensitivities and specificities. Conclusion The sensitivity of the WHO immunological criteria is poor, but the specificity is high. Although testing costs may increase, we recommend that Vietnam and other similar settings adopt viral load testing as the principal method for determining ART failure.
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Affiliation(s)
- Nicole K. Le
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States of America
| | - Emilia Riggi
- Department of Brain and Behavioural Sciences, Medical Statistics Unit, University of Pavia, Pavia, Italy
| | - Gaetano Marrone
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Tam Van Vu
- Department of Infectious Diseases, Uong Bi General Hospital, Uong Bi, Quang Ninh, Vietnam
| | - Ricardo O. Izurieta
- Department of Global Health, College of Public Health, University of South Florida, Tampa, FL, United States of America
| | | | - Mattias Larsson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Cuong Duy Do
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Infectious Diseases Department, Bach Mai Hospital, Hanoi, Vietnam
- * E-mail:
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Bulage L, Ssewanyana I, Nankabirwa V, Nsubuga F, Kihembo C, Pande G, Ario AR, Matovu JK, Wanyenze RK, Kiyaga C. Factors Associated with Virological Non-suppression among HIV-Positive Patients on Antiretroviral Therapy in Uganda, August 2014-July 2015. BMC Infect Dis 2017; 17:326. [PMID: 28468608 PMCID: PMC5415758 DOI: 10.1186/s12879-017-2428-3] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 04/28/2017] [Indexed: 01/12/2023] Open
Abstract
Background Despite the growing number of people on antiretroviral therapy (ART), there is limited information about virological non-suppression and its determinants among HIV-positive (HIV+) individuals enrolled in HIV care in many resource-limited settings. We estimated the proportion of virologically non-suppressed patients, and identified the factors associated with virological non-suppression. Methods We conducted a descriptive cross-sectional study using routinely collected program data from viral load (VL) samples collected across the country for testing at the Central Public Health Laboratories (CPHL) in Uganda. Data were generated between August 2014 and July 2015. We extracted data on socio-demographic, clinical and VL testing results. We defined virological non-suppression as having ≥1000 copies of viral RNA/ml of blood for plasma or ≥5000 copies of viral RNA/ml of blood for dry blood spots. We used logistic regression to identify factors associated with virological non-suppression. Results The study was composed of 100,678 patients; of these, 94,766(94%) were for routine monitoring, 3492(4%) were suspected treatment failures while 1436(1%) were repeat testers after suspected failure. The overall proportion of non-suppression was 11%. Patients on routine monitoring registered the lowest (10%) proportion of non-suppressed patients. Virological non-suppression was higher among suspected treatment failures (29%) and repeat testers after suspected failure (50%). Repeat testers after suspected failure were six times more likely to have virological non-suppression (ORadj = 6.3, 95%CI = 5.5–7.2) when compared with suspected treatment failures (ORadj = 3.3, 95%CI = 3.0–3.6). The odds of virological non-suppression decreased with increasing age, with children aged 0–4 years (ORadj = 5.3, 95%CI = 4.6–6.1) and young adolescents (ORadj = 4.1, 95%CI = 3.7–4.6) registering the highest odds. Poor adherence (ORadj = 3.4, 95%CI = 2.9–3.9) and having active TB (ORadj = 1.9, 95%CI = 1.6–2.4) increased the odds of virological non-suppression. However, being on second/third line regimens (ORadj = 0.86, 95%CI = 0.78–0.95) protected patients against virological non-suppression. Conclusion Young age, poor adherence and having active TB increased the odds of virological non-suppression while second/third line ART regimens were protective against non-suppression. We recommend close follow up and intensified targeted adherence support for repeat testers after suspected failure, children and adolescents.
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Affiliation(s)
- Lilian Bulage
- Uganda Public Health Fellowship Program - Field Epidemiology Track, Kampala, Uganda. .,Central Public Health Laboratories, Ministry of Health, Kampala, Uganda.
| | - Isaac Ssewanyana
- Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
| | | | - Fred Nsubuga
- Uganda Public Health Fellowship Program - Field Epidemiology Track, Kampala, Uganda
| | - Christine Kihembo
- Uganda Public Health Fellowship Program - Field Epidemiology Track, Kampala, Uganda
| | - Gerald Pande
- Uganda Public Health Fellowship Program - Field Epidemiology Track, Kampala, Uganda
| | - Alex R Ario
- Uganda Public Health Fellowship Program - Field Epidemiology Track, Kampala, Uganda
| | - Joseph Kb Matovu
- Uganda Public Health Fellowship Program - Field Epidemiology Track, Kampala, Uganda.,Makerere University School of Public Health, Kampala, Uganda
| | - Rhoda K Wanyenze
- Uganda Public Health Fellowship Program - Field Epidemiology Track, Kampala, Uganda.,Makerere University School of Public Health, Kampala, Uganda
| | - Charles Kiyaga
- Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
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Cuong DD, Sönnerborg A, Van Tam V, El-Khatib Z, Santacatterina M, Marrone G, Chuc NTK, Diwan V, Thorson A, Le NK, An PN, Larsson M. Impact of peer support on virologic failure in HIV-infected patients on antiretroviral therapy - a cluster randomized controlled trial in Vietnam. BMC Infect Dis 2016; 16:759. [PMID: 27986077 PMCID: PMC5162085 DOI: 10.1186/s12879-016-2017-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 11/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background The effect of peer support on virologic and immunologic treatment outcomes among HIVinfected patients receiving antiretroviral therapy (ART) was assessed in a cluster randomized controlled trial in Vietnam. Methods Seventy-one clusters (communes) were randomized in intervention or control, and a total of 640 patients initiating ART were enrolled. The intervention group received peer support with weekly home-visits. Both groups received first-line ART regimens according to the National Treatment Guidelines. Viral load (VL) (ExaVir™ Load) and CD4 counts were analyzed every 6 months. The primary endpoint was virologic failure (VL >1000 copies/ml). Patients were followed up for 24 months. Intention-to-treat analysis was used. Cluster longitudinal and survival analyses were used to study time to virologic failure and CD4 trends. Results Of 640 patients, 71% were males, mean age 32 years, 83% started with stavudine/lamivudine/nevirapine regimen. After a mean of 20.8 months, 78% completed the study, and the median CD4 increase was 286 cells/μl. Cumulative virologic failure risk was 7.2%. There was no significant difference between intervention and control groups in risk for and time to virologic failure and in CD4 trends. Risk factors for virologic failure were ART-non-naïve status [aHR 6.9;(95% CI 3.2–14.6); p < 0.01]; baseline VL ≥100,000 copies/ml [aHR 2.3;(95% CI 1.2–4.3); p < 0.05] and incomplete adherence (self-reported missing more than one dose during 24 months) [aHR 3.1;(95% CI 1.1–8.9); p < 0.05]. Risk factors associated with slower increase of CD4 counts were: baseline VL ≥100,000 copies/ml [adj.sq.Coeff (95% CI): −0.9 (−1.5;−0.3); p < 0.01] and baseline CD4 count <100 cells/μl [adj.sq.Coeff (95% CI): −5.7 (−6.3;−5.4); p < 0.01]. Having an HIV-infected family member was also significantly associated with gain in CD4 counts [adj.sq.Coeff (95% CI): 1.3 (0.8;1.9); p < 0.01]. Conclusion There was a low virologic failure risk during the first 2 years of ART follow-up in a rural low-income setting in Vietnam. Peer support did not show any impact on virologic and immunologic outcomes after 2 years of follow up. Trial registration NCT01433601.
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Affiliation(s)
- Do Duy Cuong
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. .,Infectious Diseases Department, Bach Mai Hospital, Hanoi, Vietnam.
| | - Anders Sönnerborg
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Virology, Department of Laboratory Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Vu Van Tam
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Vietnam-Sweden Uong Bi General Hospital, Quang Ninh, Vietnam
| | - Ziad El-Khatib
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,World Health Programme, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Canada
| | - Michele Santacatterina
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gaetano Marrone
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Vinod Diwan
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Anna Thorson
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Nicole K Le
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | - Mattias Larsson
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. .,Oxford University Clinical Research Unit (OUCRU), Hanoi, Vietnam.
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Tran DA, Wilson DP, Shakeshaft A, Ngo AD, Doran C, Zhang L. Determinants of virological failure after 1 year's antiretroviral therapy in Vietnamese people with HIV: findings from a retrospective cohort of 13 outpatient clinics in six provinces. Sex Transm Infect 2014; 90:538-44. [PMID: 24619575 DOI: 10.1136/sextrans-2013-051353] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study examines the proportions and causes of virological failure after one year of antiretroviral therapy (ART) among people living with HIV (PLHIV) in Vietnam. It also evaluates the positive predictive value (PPV) of immunological criteria to detect treatment failure. METHOD A retrospective cohort of 3449 people with HIV who started ART between 1 January 2005 and 31 December 2009 in 13 outpatient clinics in Vietnam was studied. Multivariate logistic regression modeling was used to calculate crude and adjusted ORs and 95% CIs for associations between patient characteristics and virological failure. RESULTS An estimated 6.5% (226/3449) of HIV patients in the participating clinics in Vietnam had confirmed virological failure one year after the start of ART. After adjusting for other factors, patients with a baseline CD4 count of 50-100 cells/mm(3) and 101-200 cells/mm(3) were statistically significantly less likely to have virological failure, compared to those with a baseline CD4 count lower than 50 cells/mm(3) (OR=0.61, 95% CI 0.23-0.89; and OR=0.43, 0.18-0.78, respectively). In contrast, patients with a history of injecting drug use were statistically significantly more likely to have viraemia than otherwise (OR=1.32, 1.16-1.67). The PPV of the WHO immunological criteria was 60.1% (57.1-69.3%). CONCLUSIONS Routine viral load tests should be conducted early to detect virological failure and prevent unnecessary changes to second-line treatments. To improve treatment outcomes, timely ART initiation and adherence to treatment among those with history of injecting drug use should be promoted.
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Affiliation(s)
- Dam Anh Tran
- Kirby Institute, The University of New South Wales, Sydney, New South Wales, Australia National Drug Alcohol Research Centre, The University of New South Wales, Sydney, New South Wales, Australia
| | - David P Wilson
- Kirby Institute, The University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony Shakeshaft
- National Drug Alcohol Research Centre, The University of New South Wales, Sydney, New South Wales, Australia
| | - Anh Duc Ngo
- The University of South Australia, Adelaide, South Australia, Australia
| | - Christopher Doran
- Hunter Medical Research Centre, The University of Newcastle, Newcastle, Australia
| | - Lei Zhang
- Kirby Institute, The University of New South Wales, Sydney, New South Wales, Australia
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Alave J, Paz J, González E, Campos M, Rodríguez M, Willig J, Echevarría J. [Risk factors associated with virologic failure in HIV- infected patients receiving antiretroviral therapy at a public hospital in Peru]. Rev Chilena Infectol 2013; 30:42-8. [PMID: 23450408 DOI: 10.4067/s0716-10182013000100006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Accepted: 11/17/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To describe clinical and biological characteristics of subjects with virologic failure who participated in the sexually transmitted diseases HIV/AIDS National Program from a Peruvian public hospital. MATERIALS AND METHODS An exploratory descriptive study was performed with data from subjects older than 18 who started high activity antiretroviral therapy (HAART) between May 2004 and December 2009 and who had a viral load control after 24 weeks of HAART. Virologic failure was defined as a viral load value above 1000 copies/mL on follow up after 24 weeks on HAART. RESULTS Of 1478 records of patients on HAART analyzed, the median age was 35 years [IQR, 29-41] and 69.6% were male. Also, virologic failure occurred in 24% and 3.7% died. Of subjects with virologic failure, 9.5% died. On multivariate analysis, age, history of antiretroviral use before starting HAART, change of antiretroviral therapy due to toxicity, opportunistic infections during HAART, level of CD4 + lymphocytes below 100 cells/ml at start of HAART, adherence and clinical stage were independently associated with virologic failure. In the group of patient with no history of antiretroviral use before starting HAART, age, opportunistic infections during HAART were associated with virologic failure. CONCLUSION This study identified factors associated with virologic failure. Further studies are needed to evaluate whether the use of these factors can help to identify prospectively patients at high risk of failure, and to design interventions aimed to reduce this risk.
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Affiliation(s)
- Jorge Alave
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú.
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12
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Ndawinz JDA, Chaix B, Koulla-Shiro S, Delaporte E, Okouda B, Abanda A, Tchomthe S, Mboui E, Costagliola D, Supervie V. Factors associated with late antiretroviral therapy initiation in Cameroon: a representative multilevel analysis. J Antimicrob Chemother 2013; 68:1388-99. [PMID: 23391713 DOI: 10.1093/jac/dkt011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Many people living with HIV/AIDS in resource-limited settings begin antiretroviral therapy (ART) at low CD4 counts. Here, we investigated the simultaneous effect of individual-, facility- and regional-level factors on late ART initiation. METHODS We conducted a survey in a nationally representative sample of 55 HIV treatment facilities in Cameroon. Medical records of 4935 patients >15 years of age who initiated ART in the month of October during the period 2007-10 were reviewed to gather individual characteristics. Late ART initiation was defined as CD4 count ≤ 100 cells/mm(3). Facility- and regional-level characteristics were also collected. Two-level regression logistic models were used to identify factors associated with late ART initiation. RESULTS Late ART initiation was associated with being a male younger than 45 years versus female younger than 45 years [adjusted OR (AOR) = 1.5, 95% CI: 1.3-1.7] and initiating ART in the period 2007-09 versus 2010 (AOR = 1.2, 95% CI: 1.0-1.4). Late initiation was more likely in central than in district hospitals (AOR = 1.3, 95% CI: 1.1-1.6) and in hospitals without a mother-to-child transmission programme (AOR = 1.9, 95% CI: 1.3-2.8). Living in a region with a higher comprehensive knowledge of HIV/AIDS was associated with not initiating ART late (AOR = 0.8, 95% CI: 0.6-1.0). CONCLUSIONS This study shows that risk factors associated with late ART initiation operate at multiple levels and that multilevel interventions are therefore necessary to promote earlier HIV testing and treatment.
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Cuong DD, Agneskog E, Chuc NTK, Santacatterina M, Sönnerborg A, Larsson M. Monitoring the efficacy of antiretroviral therapy by a simple reverse transcriptase assay in HIV-infected adults in rural Vietnam. Future Virol 2012. [DOI: 10.2217/fvl.12.83] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: To determine the feasibility of viral load (VL) monitoring using ExaVir™ Load in a cohort of 605 HIV treatment-naive adult patients initiating antiretroviral therapy in rural Vietnam. Materials & methods: VL monitoring every 6 months, survival and intention-to-treat analysis were used. Roche Cobas TaqMan® VL was compared with ExaVir Load using Spearman’s rank correlation coefficient and Bland–Altman analysis. Results: After 20.7 months mean follow-up time, 78% remained on treatment. Virologic suppression rate (VL <200 copies/ml) after 24 months was 64% in the whole cohort and 94% among patients assessed with VL. The cumulative virologic failure rate (VL >1000 copies/ml) was 6.8%. Baseline VL ≥100,000 copies/ml was predictive for virologic failure [adjusted hazard ratio: 2.26 (1.16–4.39); p = 0.016]. ExaVir Load and the Roche Cobas TaqMan showed a strong correlation (r2 = 0.97; p < 0.001), high agreement (difference in log = 0.34; 95% CI: -0.35–1.03), high sensitivity (98%) and high specificity (100%). Conclusion: Using ExaVir Load to monitor efficacy of antiretroviral therapy programs in resource-limited settings is feasible.
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Affiliation(s)
- Do Duy Cuong
- Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Eva Agneskog
- Division of Clinical Virology, Department of Laboratory Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | | | - Michele Santacatterina
- Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Anders Sönnerborg
- Division of Clinical Virology, Department of Laboratory Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Larsson
- Oxford University Clinical Research Unit (OUCRU), Hanoi, Vietnam
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M. Kwobah C, W. Mwangi A, K. Koech J, N. Simiyu G, M. Siika A. Factors Associated with First-Line Antiretroviral Therapy Failure amongst HIV-Infected African Patients: A Case-Control Study. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/wja.2012.24036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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