Antiretroviral Treatment Adherence as a Mediating Factor Between Psychosocial Variables and HIV Viral Load

Abstract Background Progress toward the global target for 95% virological suppression among those on antiretroviral treatment (ART) is still suboptimal. We describe the viral load (VL) cascade, the incidence of virological failure and associated risk factors among people living with HIV receiving first-line ART in an HIV cohort in Myanmar treated by the Médecins Sans Frontières in collaboration with the Ministry of Health and Sports Myanmar. Methods We conducted a retrospective cohort study, including adult patients with at least one HIV viral load test result and having received of at least 6 months’ standard first-line ART. The incidence rate of virological failure (HIV viral load ≥ 1000 copies/mL) was calculated. Multivariable Cox’s regression was performed to identify risk factors for virological failure. Results We included 25,260 patients with a median age of 33.1 years (interquartile range, IQR 28.0–39.1) and a median observation time of 5.4 years (IQR 3.7–7.9). Virological failure was documented in 3,579 (14.2%) participants, resulting in an overall incidence rate for failure of 2.5 per 100 person-years of follow-up. Among those who had a follow-up viral load result, 1,258 (57.1%) had confirmed virological failure, of which 836 (66.5%) were switched to second-line treatment. An increased hazard for failure was associated with age ≤ 19 years (adjusted hazard ratio, aHR 1.51; 95% confidence intervals, CI 1.20–1.89; p < 0.001), baseline tuberculosis (aHR 1.39; 95% CI 1.14–1.49; p < 0.001), a history of low-level viremia (aHR 1.60; 95% CI 1.42–1.81; p < 0.001), or a history of loss-to-follow-up (aHR 1.24; 95% CI 1.41–1.52; p = 0.041) and being on the same regimen (aHR 1.37; 95% CI 1.07–1.76; p < 0.001). Cumulative appointment delay was not significantly associated with failure after controlling for covariates. Conclusions VL monitoring is an important tool to improve programme outcomes, however limited coverage of VL testing and acting on test results hampers its full potential. In our cohort children and adolescents, PLHIV with history of loss-to-follow-up or those with low-viremia are at the highest risk of virological failure and might require more frequent virological monitoring than is currently recommended.

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Trends in CD4 counts in HIV-infected patients with HIV viral load monitoring while on combination antiretroviral treatment: results from The TREAT Asia HIV Observational Database

BMC Infectious Diseases ◽

10.1186/1471-2334-10-361 ◽

2010 ◽

Vol 10 (1) ◽

Cited By ~ 17

Author(s):

Jialun Zhou ◽

Thira Sirisanthana ◽

Sasisopin Kiertiburanakul ◽

Yi-Ming A Chen ◽

Ning Han ◽

...

Keyword(s):

Viral Load ◽

Antiretroviral Treatment ◽

Treatment Results ◽

Hiv Viral Load ◽

Cd4 Counts ◽

Observational Database ◽

Viral Load Monitoring ◽

Load Monitoring

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Suboptimal Immune Reconstitution among HIV-Infected Saudi Patients following Successful Antiretroviral Treatment

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2019/1842106 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Fahad Al-Majid ◽

Zahid Shakoor ◽

Mazin Barry

Keyword(s):

Viral Load ◽

Immune Reconstitution ◽

Antiretroviral Treatment ◽

Population Expansion ◽

Hiv Viral Load ◽

Hiv Patients ◽

Delayed Treatment ◽

Hla Dr ◽

Before And After ◽

Saudi Patients

Background and Objectives. Variations in immune reconstitution following antiretroviral treatment (ART) among HIV patients have previously been observed. This study aims at assessing immune reconstitution after successful ART among HIV-infected Saudi patients.Methods. This retrospective study of 240 HIV-infected patients was performed between May 2010 and June 2015 in the HIV center at King Saud Hospital, Riyadh. Data were extracted for CD4, CD8 cell, and CD3/HLA-DR counts along with the viral load from patient records before and after four years of successful ART. The inclusion criterion was patients with CD4 reconstitution of either equal to or more than 400 cells/mm3with an undetectable HIV viral load following ART. Based on their presentation, the HIV patients were grouped into early treatment (ET) and delayed treatment (DT) groups with CD4 counts of 200–350 cells/mm3and less than 200 cells/mm3, respectively.Findings. The pretreatment CD8+ counts of median 865 cells/mm3(interquartile range (IQR) 774–1072) in the DT group declined to median 753 cells/mm3(IQR 574–987;p<0.0001). Moreover, there was a decline in CD8 counts from 703 cells/mm3(IQR 655–747) to 620 cells/mm3(IQR 563–645;p<0.04) in the ET group after four years of successful ART. Pretreatment activation marker (CD3/HLA-DR+) expression of median 29% in the DT group declined to 22% and in the ET group from a median of 23% to 19% after treatment. The CD4/CD8 ratio in the DT group increased from 0.14 (IQR 0.09–0.88) to 0.71 (IQR 0.54–0.9) and from 0.42 (IQR 0.35–0.55) to 0.87 (IQR 0.71–0.98) in the ET group.Conclusion. Immune reconstitution after successful ART among HIV-infected Saudi patients was associated with a CD8 T-cell population expansion with a suboptimal CD4/CD8 ratio and persistent immune activation. Early initiation of ART appears to favorably influence the CD4/CD8 ratio.

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