TY - JOUR
T1 - Monitoring and switching of first-line antiretroviral therapy in adult treatment cohorts in sub-Saharan Africa
T2 - Collaborative analysis
AU - IeDEA southern Africa, east Africa, and west Africa
AU - Haas, Andreas D.
AU - Keiser, Olivia
AU - Balestre, Eric
AU - Brown, Steve
AU - Bissagnene, Emmanuel
AU - Chimbetete, Cleophas
AU - Dabis, François
AU - Davies, Mary Ann
AU - Hoffmann, Christopher J.
AU - Oyaro, Patrick
AU - Parkes-Ratanshi, Rosalind
AU - Reynolds, Steven J.
AU - Sikazwe, Izukanji
AU - Wools-Kaloustian, Kara
AU - Zannou, D. Marcel
AU - Wandeler, Gilles
AU - Egger, Matthias
AU - Boulle, Andrew
AU - Campbell, Lucy
AU - Cornell, Morna
AU - Johnson, Leigh
AU - Maxwell, Nicola
AU - Myer, Landon
AU - Schomaker, Michael
AU - Porter, Mireille
AU - Nalugoda, Fred
AU - Chi, Benjamin
AU - Tanser, Frank
AU - Hoffimann, Christopher
AU - Naniche, Denise
AU - Wood, Robin
AU - Stinson, Kathryn
AU - Fatti, Geoffirey
AU - Phiri, Sam
AU - Giddy, Janet
AU - Malisita, Kennedy
AU - Eley, Brian
AU - Hobbins, Michael
AU - Kamenova, Kamelia
AU - Faturiyele, Olatunbosun
AU - Fox, Matthew
AU - Prozesky, Hans
AU - Technau, Karl
AU - Sawry, Shobna
AU - Bohlius, Julia
AU - Blaser, Nello
AU - Estill, Janne
AU - Salazar-Vizcaya, Luisa
AU - Haas, Andreas
AU - Ballif, Marie
N1 - Funding Information:
We thank all patients who contributed data to this study. This study was funded by the National Institute of Allergy and Infectious Diseases ( 5U01-AI069924, U01AI069911, U01AI069919 ). SJR was funded by the Division of Intramural Research, National Institute of Allergy and Infectious Diseases. OK was funded by the Swiss National Science Foundation ( Ambizione/Prosper grant 32333B_131629 ).
PY - 2015/7/1
Y1 - 2015/7/1
N2 - Background HIV-1 viral load testing is recommended to monitor antiretroviral therapy (ART) but is not universally available. The aim of our study was to assess monitoring of first-line ART and switching to second-line ART in sub-Saharan Africa. Methods We did a collaborative analysis of cohort studies from 16 countries in east Africa, southern Africa, and west Africa that participate in the international epidemiological database to evaluate AIDS (IeDEA). We included adults infected with HIV-1 who started combination ART between January, 2004, and January, 2013. We defined switching of ART as a change from a non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based regimen to one including a protease inhibitor, with adjustment of one or more nucleoside reverse-transcriptase inhibitors (NRTIs). Virological and immunological failures were defined according to WHO criteria. We calculated cumulative probabilities of switching and hazard ratios with 95% CIs comparing routine viral load monitoring, targeted viral load monitoring, CD4 monitoring, and clinical monitoring, adjusting for programme and individual characteristics. Findings Of 297 825 eligible patients, 10 352 (3%) switched to second-line ART during 782 412 person-years of follow-up. Compared with CD4 monitoring, hazard ratios for switching were 3.15 (95% CI 2.92-3.40) for routine viral load monitoring, 1.21 (1.13-1.30) for targeted viral load monitoring, and 0.49 (0.43-0.56) for clinical monitoring. Of 6450 patients with confirmed virological failure, 58.0% (95% CI 56.5-59.6) switched by 2 years, and of 15 892 patients with confirmed immunological failure, 19.3% (18.5-20.0) switched by 2 years. Of 10 352 patients who switched, evidence of treatment failure based on one CD4 count or viral load measurement ranged from 86 (32%) of 268 patients with clinical monitoring to 3754 (84%) of 4452 with targeted viral load monitoring. Median CD4 counts at switching were 215 cells per μL (IQR 117-335) with routine viral load monitoring, but were lower with other types of monitoring (range 114-133 cells per μL). Interpretation Overall, few patients switched to second-line ART and switching happened late in the absence of routine viral load monitoring. Switching was more common and happened earlier after initiation of ART with targeted or routine viral load testing.
AB - Background HIV-1 viral load testing is recommended to monitor antiretroviral therapy (ART) but is not universally available. The aim of our study was to assess monitoring of first-line ART and switching to second-line ART in sub-Saharan Africa. Methods We did a collaborative analysis of cohort studies from 16 countries in east Africa, southern Africa, and west Africa that participate in the international epidemiological database to evaluate AIDS (IeDEA). We included adults infected with HIV-1 who started combination ART between January, 2004, and January, 2013. We defined switching of ART as a change from a non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based regimen to one including a protease inhibitor, with adjustment of one or more nucleoside reverse-transcriptase inhibitors (NRTIs). Virological and immunological failures were defined according to WHO criteria. We calculated cumulative probabilities of switching and hazard ratios with 95% CIs comparing routine viral load monitoring, targeted viral load monitoring, CD4 monitoring, and clinical monitoring, adjusting for programme and individual characteristics. Findings Of 297 825 eligible patients, 10 352 (3%) switched to second-line ART during 782 412 person-years of follow-up. Compared with CD4 monitoring, hazard ratios for switching were 3.15 (95% CI 2.92-3.40) for routine viral load monitoring, 1.21 (1.13-1.30) for targeted viral load monitoring, and 0.49 (0.43-0.56) for clinical monitoring. Of 6450 patients with confirmed virological failure, 58.0% (95% CI 56.5-59.6) switched by 2 years, and of 15 892 patients with confirmed immunological failure, 19.3% (18.5-20.0) switched by 2 years. Of 10 352 patients who switched, evidence of treatment failure based on one CD4 count or viral load measurement ranged from 86 (32%) of 268 patients with clinical monitoring to 3754 (84%) of 4452 with targeted viral load monitoring. Median CD4 counts at switching were 215 cells per μL (IQR 117-335) with routine viral load monitoring, but were lower with other types of monitoring (range 114-133 cells per μL). Interpretation Overall, few patients switched to second-line ART and switching happened late in the absence of routine viral load monitoring. Switching was more common and happened earlier after initiation of ART with targeted or routine viral load testing.
UR - http://www.scopus.com/inward/record.url?scp=84947041939&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84947041939&partnerID=8YFLogxK
U2 - 10.1016/S2352-3018(15)00087-9
DO - 10.1016/S2352-3018(15)00087-9
M3 - Article
C2 - 26423252
AN - SCOPUS:84947041939
SN - 2352-3018
VL - 2
SP - e271-e278
JO - The Lancet HIV
JF - The Lancet HIV
IS - 7
ER -