Introduction: Viral load (VL) testing is still challenging to monitor treatment responses of antiretroviral therapy (ART) for HIV treatment programme in Asia. We assessed the association between routine VL testing and virological failure (VF) and determine factors associated with switching to second-line regimen. Methods: Among 21 sites from the TREAT Asia HIV Observational Database (TAHOD), people living with HIV (PLHIV) aged ≥18 years initiating ART from 2003 to 2021 were included. We calculated the average number of VL tests per patient per year between the date of ART initiation and the most recent visit. If the median average number of VL tests was ≥ 0.80 per patient per year, the site was classified as a routine VL site. A site with a median < 0.80 was classified into the non-routine VL sites. VF was defined as VL ≥1000 copies/ml during first-line therapy. Factors associated with VF were analysed using generalized estimating equations with Poisson distribution. Results: Of 6277 PLHIV starting ART after 2003, 3030 (48%) were from 11 routine VL testing sites and 3247 (52%) were from 10 non-routine VL testing sites. The median follow-up was 9 years (IQR 5–13). The median age was 35 (30–42) years; 68% were male and 5729 (91%) started non-nucleoside reverse-transcriptase inhibitor-based regimen. The median pre-ART CD4 count in PLHIV from routine VL sites was lower compared to non-routine VL sites (144 vs. 156 cells/mm3, p <0.001). Overall, 1021 subsequent VF at a rate of 2.15 (95% CI 2.02–2.29) per 100 person-years (PY). VF was more frequent at non-routine VL sites (adjusted incidence rate ratio 2.85 [95% CI 2.27–3.59]) compared to routine VL sites. Other factors associated with an increased rate of VF were age <50 years and CD4 count <350 cells/mm3. A total of 817 (13%) patients switched to second-line regimen at a rate of 1.44 (95% CI 1.35–1.54) per 100 PY. PLHIV at routine VL monitoring sites were at higher risk of switching than those at non-routine VL sites (adjusted sub-hazard ratio 1.78 95% CI [1.17–2.71]). Conclusions: PLHIV from non-routine VL sites had a higher incidence of persistent VF and a low switching regimen rate, reflecting possible under-utilized VL testing.
|Journal||Journal of the International AIDS Society|
|Publication status||Published - 2022 Aug|
Bibliographical noteFunding Information:
The TREAT Asia HIV Observational Database is an initiative of TREAT Asia, a programme of amfAR, The Foundation for AIDS Research, with support from the U.S. National Institutes of Health's National Institute of Allergy and Infectious Diseases, the National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute of Mental Health, the National Institute on Drug Abuse, the National Heart, Lung, and Blood Institute, the National Institute on Alcohol Abuse and Alcoholism, the National Institute of Diabetes and Digestive and Kidney Diseases and the Fogarty International Center, as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA; U01AI069907). Eunice Kennedy Shriver
The Kirby Institute is funded by the Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, UNSW Sydney. International SciKU Branding (ISB) is funded by the Faculty of Science, Kasetsart University. The TREAT Asia HIV Observational Database is an initiative of TREAT Asia, a programme of amfAR, The Foundation for AIDS Research, with support from the U.S. National Institutes of Health's National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute of Mental Health, the National Institute on Drug Abuse, the National Heart, Lung, and Blood Institute, the National Institute on Alcohol Abuse and Alcoholism, the National Institute of Diabetes and Digestive and Kidney Diseases and the Fogarty International Center, as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA; U01AI069907).
The Kirby Institute is funded by the Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, UNSW Sydney. International SciKU Branding (ISB) is funded by the Faculty of Science, Kasetsart University.
PS Ly*, V Khol, National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia; FJ Zhang*, HX Zhao, N Han, Beijing Ditan Hospital, Capital Medical University, Beijing, China; MP Lee*, PCK Li, TS Kwong, TH Li, Queen Elizabeth Hospital, Hong Kong SAR; N Kumarasamy*, C Ezhilarasi, Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS‐Infectious Diseases Medical Centre, VHS, Chennai, India; S Pujari*, K Joshi, S Gaikwad, A Chitalikar, Institute of Infectious Diseases, Pune, India; RT Borse*, V Mave, I Marbaniang, S Nimkar, BJ Government Medical College and Sassoon General Hospital, Pune, India; TP Merati*, IKA Somia, AAS Sawitri, F Yuliana, Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia; E Yunihastuti*, A Widhani, S Maria, TH Karjadi, Faculty of Medicine Universitas Indonesia ‐ Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; J Tanuma*, S Oka, T Nishijima, National Center for Global Health and Medicine, Tokyo, Japan; JY Choi*, Na S, JM Kim, Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; YM Gani*, NB Rudi, Hospital Sungai Buloh, Sungai Buloh, Malaysia; I Azwa*, A Kamarulzaman, SF Syed Omar, S Ponnampalavanar, University Malaya Medical Centre, Kuala Lumpur, Malaysia; R Ditangco*, MK Pasayan, ML Mationg, Research Institute for Tropical Medicine, Muntinlupa City, Philippines; YJ Chan*, WW Ku, PC Wu, E Ke, Taipei Veterans General Hospital, Taipei, Taiwan; OT Ng*, PL Lim, LS Lee, T Yap, Tan Tock Seng Hospital, National Centre for Infectious Diseases, Singapore (note: OT Ng is also supported by the Singapore Ministry of Health's (MOH) National Medical Research Council (NMRC) Clinician Scientist Award (MOH‐000276). Any opinions, findings and conclusions or recommendations expressed in this material are those of the author(s) and do not reflect the views of MOH/NMRC; A Avihingsanon*, S Gatechompol, P Phanuphak, C Phadungphon, HIV‐NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand; S Kiertiburanakul*, A Phuphuakrat, L Chumla, N Sanmeema, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; R Chaiwarith*, T Sirisanthana, J Praparattanapan, K Nuket, Chiang Mai University ‐ Research Institute for Health Sciences, Chiang Mai, Thailand; S Khusuwan*, P Payoong, P Kantipong, P Kambua, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand; TN Pham*, KV Nguyen, DTH Nguyen, DT Nguyen, National Hospital for Tropical Diseases, Hanoi, Vietnam; CD Do*, AV Ngo, LT Nguyen, Bach Mai Hospital, Hanoi, Vietnam; AH Sohn*, JL Ross*, B Petersen, TREAT Asia, amfAR ‐ The Foundation for AIDS Research, Bangkok, Thailand; MG Law*, A Jiamsakul*, D Rupasinghe, The Kirby Institute, UNSW Sydney, NSW, Australia. * TAHOD Steering Committee member.
© 2022 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.
All Science Journal Classification (ASJC) codes
- Public Health, Environmental and Occupational Health
- Infectious Diseases