Long-term viral suppression and immune recovery during first-line antiretroviral therapy: a study of an HIV-infected adult cohort in Hanoi, Vietnam

Abstract Background Monocyte dysfunction may persist during antiretroviral therapy (ART). Methods Frozen peripheral blood mononuclear cells of 30 human immunodeficiency virus (HIV)-infected ART-treated adults with sustained viral suppression and CD4 counts ≥500 cells/µL were consecutively analyzed for monocyte phenotypes and function. Results Nonclassical monocytes (CD14+, CD16++), interleukin (IL)-1β production, and expression of CD40 and CD86 were lower among ART-treated HIV-infected adults relative to age-matched HIV-negative adults (P = .01, P = .01, and P = .02, respectively). Intestinal fatty acid-binding protein, IL6, and soluble CD14 were higher among HIV-infected adults relative to HIV-negative adults (P = .0002, P = .04, and P = .0017, respectively). Conclusions Further investigation is required to understand drivers of persistent monocyte activation and dysfunction.

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Engagement in Care, Viral Suppression, Drug Resistance, and Reasons for Nonengagement After Home-Based Same-Day Antiretroviral Therapy Initiation in Lesotho: A Two-Year Follow-up of the CASCADE Trial

Clinical Infectious Diseases ◽

10.1093/cid/ciz1126 ◽

2019 ◽

Vol 71 (10) ◽

pp. 2608-2614 ◽

Cited By ~ 3

Author(s):

Alain Amstutz ◽

Jennifer Anne Brown ◽

Isaac Ringera ◽

Josephine Muhairwe ◽

Thabo Ishmael Lejone ◽

...

Keyword(s):

Drug Resistance ◽

Antiretroviral Therapy ◽

Viral Suppression ◽

Human Immunodeficiency Virus Testing ◽

Long Term Results ◽

Absolute Difference ◽

Engagement In Care ◽

Resistance Mutations ◽

Home Based

Abstract Background The CASCADE trial showed that compared with usual care (UC), offering same-day (SD) antiretroviral therapy (ART) during home-based human immunodeficiency virus testing improved engagement in care and viral suppression 12 months after diagnosis. However, questions remain regarding long-term outcomes and the risk of propagating drug resistance. Methods After completion of the primary endpoint at 12 months, participants not in care in both arms were traced and encouraged to access care. At 24 months, the following outcomes were assessed in both arms: engagement in care, viral suppression, and reasons for nonengagement. Furthermore, we explored the acquisition of drug resistance mutations (DRMs) among SD arm nonlinkers. Results At 24 months, 64% (88/137) in the SD arm vs 59% (81/137) in the UC arm were in care (absolute difference [AD], 5%; 95% confidence interval [CI], −6 to16; P = .38) and 57% (78/137) vs 54% (74/137) had documented viral suppression (AD, 3%; 95% CI, −9 to 15; P = .28). Among 36 participants alive and not in care at 24 months with ascertained status, the majority rejected contact with the health system or were unwilling to take ART. Among 8 interviewed SD arm nonlinkers, 6 had not initiated ART upon enrollment, and no acquired DRMs were detected. Two had taken the initial 30-day ART supply and acquired DRMs. Conclusions SD ART resulted in higher rates of engagement in care and viral suppression at 12 months but not at 24 months. Leveling off between both arms was driven by linkage beyond 12 months in the UC arm. We did not observe compensatory long-term disengagement in the SD arm. These long-term results endorse SD ART initiation policies. Clinical Trials Registration NCT02692027.

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High Level of Viral Suppression and Low Switch Rate to Second-Line Antiretroviral Therapy among HIV-Infected Adult Patients Followed over Five Years: Retrospective Analysis of the DART Trial

PLoS ONE ◽

10.1371/journal.pone.0090772 ◽

2014 ◽

Vol 9 (3) ◽

pp. e90772 ◽

Cited By ~ 5

Author(s):

Cissy Kityo ◽

Diana M. Gibb ◽

Charles F. Gilks ◽

Ruth L. Goodall ◽

Ivan Mambule ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Retrospective Analysis ◽

Viral Suppression ◽

Adult Patients ◽

Second Line ◽

Infected Adult ◽

Switch Rate ◽

High Level ◽

Second Line Antiretroviral Therapy

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Comment on “Higher CNS Penetration-Effectiveness of Long-Term Combination Antiretroviral Therapy is Associated With Better HIV-1 Viral Suppression in Cerebrospinal Fluid”

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0b013e3182809d9f ◽

2013 ◽

Vol 62 (4) ◽

pp. e118-e119 ◽

Cited By ~ 1

Author(s):

Andrea Calcagno ◽

Antonio DʼAvolio ◽

Giovanni Di Perri ◽

Stefano Bonora

Keyword(s):

Cerebrospinal Fluid ◽

Antiretroviral Therapy ◽

Viral Suppression ◽

Combination Antiretroviral Therapy ◽

Cns Penetration ◽

Cns Penetration Effectiveness ◽

Hiv 1

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Factors associated with recent unsuppressed viral load in HIV-1-infected patients in care on first-line antiretroviral therapy in South Africa

International Journal of STD & AIDS ◽

10.1177/0956462417748859 ◽

2018 ◽

Vol 29 (6) ◽

pp. 603-610 ◽

Cited By ~ 10

Author(s):

D Joseph Davey ◽

Z Abrahams ◽

M Feinberg ◽

M Prins ◽

C Serrao ◽

...

Keyword(s):

Viral Load ◽

Antiretroviral Therapy ◽

Viral Suppression ◽

A Priori ◽

Public Healthcare ◽

First Line ◽

Targeted Interventions ◽

Factors Associated ◽

Tb Treatment ◽

Prior Art

Unsuppressed viral load (VL) in patients on antiretroviral therapy (ART) occurs when treatment fails to suppress a person’s VL and is associated with decreased survival and increased HIV transmission. The objective of this study was to evaluate factors associated with unsuppressed VL (VL > 400 copies/ml) in patients currently in care on first-line ART for ≥ 6 months attending South African public healthcare facilities. We analysed electronic medical records of ART patients with a VL result on record who started ART between January 2004 and April 2016 from 271 public health facilities. We present descriptive and multivariable logistic regression for unsuppressed VL at last visit using a priori variables. We included 244,370 patients (69% female) on first-line ART in April 2016 for ≥ 6 months. Median age at ART start was 33 years (7% were < 15 years old). Median duration on ART was 3.7 years. Adjusting for other variables, factors associated with having an unsuppressed VL at the most recent visit among patients in care included: (1) < 15 years old at ART start (adjusted odds ratio [aOR]=2.58; 95% CI = 2.37, 2.81) versus 15–49 years at ART start, (2) male gender (aOR = 1.29; 95% CI = 1.25, 1.35), (3) 6–12 months on ART versus longer (aOR = 1.34; 95% CI = 1.29, 1.40), (4) on tuberculosis (TB) treatment (aOR = 1.78; 95% CI = 1.48, 2.13), and (5) prior ART exposure versus none (aOR = 1.20; 95% CI = 1.08, 1.32). Approximately 85% of the ART cohort who were in care had achieved viral suppression, though men, youth/adolescents, patients with prior ART exposure, those with short duration of ART, and patients on TB treatment had increased odds of not achieving viral suppression. There is a need to develop and evaluate targeted interventions for ART patients in care who are at high risk of unsuppressed VL.

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Superior Outcomes With Continuing Tenofovir Versus Switching to Zidovudine in Second-Line Antiretroviral Therapy in Haiti

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab559 ◽

2021 ◽

Vol 8 (12) ◽

Author(s):

Samuel Pierre ◽

Iryna Bocharova ◽

Catherine Nguyen ◽

Fabienne Homeus ◽

Gaetane Julmiste ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Protease Inhibitor ◽

Tenofovir Disoproxil Fumarate ◽

Viral Suppression ◽

Second Line ◽

First Line ◽

Second Line Antiretroviral Therapy

Abstract We compared viral suppression rates between patients who continued tenofovir disoproxil fumarate (TDF)/lamivudine (3TC) vs switched to zidovudine (ZDV)/3TC in combination with a boosted protease inhibitor after failure of first-line efavirenz/TDF/3TC. We found higher rates of viral suppression with continued TDF/3TC compared with switching to ZDV/3TC.

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