scholarly journals P078 Viral load monitoring for people living with HIV in the era of Test and Treat – an updated systematic review

2021 ◽  
Author(s):  
M Pham
Keyword(s):  
Systematic Review ◽  
Viral Load ◽  
People Living With Hiv ◽  
Test And Treat ◽  
Viral Load Monitoring ◽  
Load Monitoring ◽  
Living With Hiv

Viral Load Monitoring for People Living with HIV in the Era of Test and Treat: Progress Made and Challenges Ahead – A Systematic Review

2021 ◽  
Author(s):  
Minh D. Pham ◽  
Huy V. Nguyen ◽  
David Anderson ◽  
Suzanne Crowe ◽  
Stanley Luchters
Keyword(s):  
Systematic Review ◽  
Viral Load ◽  
Viral Suppression ◽  
Search Strategy ◽  
People Living With Hiv ◽  
Community Based ◽  
Viral Load Monitoring ◽  
Load Monitoring ◽  
Living With Hiv

Abstract Background Treatment of HIV with antiretroviral therapy (ART) can improve the health of people living with HIV (PLHIV), stop onward transmission of HIV and effectively prevent the spread of the virus. In 2016, we conducted a systematic review to assess the feasibility of treatment monitoring for PLHIV on ART in low and middle-income countries (LMICs), in line with the 90-90-90 treatment target. By 2020, global estimates suggest the 90-90-90 target remains unattainable in many LMICs. This study aims to review the progress and identify needs for public health interventions to improve viral load monitoring and viral suppression for PLHIV in LMICs. Methods A literature search was conducted using an update of the initial search strategy developed for the 2016 review with key search terms relevant to HIV treatment and care, decentralization and viral load monitoring. Electronic databases (Medline and PubMed) were searched to identify relevant literature published in English between Dec 2015 and August 2021. The primary outcome was initial viral load (VL) monitoring (the proportion of PLHIV on ART and eligible for VL monitoring who received a VL test). Secondary outcomes included follow-up VL monitoring (the proportion of PLHIV who received a follow-up VL after an initial elevated VL test), confirmation of treatment failure (the proportion of PLHIV who had two consecutive elevated VL results) and switching treatment regimen rates (the proportion of PLHIV who switched treatment regimen after confirmation of treatment failure). Results The search strategy identified 1984 non-duplicate records, of which 34 studies were included in the review. More than 85% (29/34) of included studies were conducted in 11 sub-Saharan African countries (SSA) using routinely collected program data; two studies were conducted among key populations (KPs) attending research clinics. Sixty per cent (20/34) of these studies were designed to evaluate VL monitoring and/or VL cascade among PLHIV on ART, and most were published in 2019–2021. Marked variations in initial VL monitoring coverage were reported across study settings/countries (range: 12–93% median: 74% IQR: 46-82%) and study populations (adults (range: 25–96%, median: 67% IQR: 50-84%), children, adolescents/young people (range: 2–94%, median: 72% IQR: 47-85%), and pregnant women (range: 32–82%, median: 57% IQR: 43-71%)). Community-based models reported higher VL monitoring (median: 85%, IQR: 82%-88%) compared to decentralised care at primary health facility (median: 64%, IRQ: 48%-82%). Suboptimal uptake of follow-up VL monitoring and low regimen switching rates were observed. Conclusions There was a marked increase in the number of studies of VL monitoring for PLHIV on ART in LMICs over the past five years. Substantial gaps in VL coverage across study settings and study populations were evident, with limited data availability outside of SSA and in KPs. Further research is needed to fill the data gaps. Development and implementation of innovative, community-based interventions are required to improve VL monitoring and address the “failure cascade” in PLHIV on ART who fail to achieve viral suppression.

scholarly journals 886. The Impact of the COVID-19 Pandemic on Clinical Follow-Up, Monitoring and Regimen Discontinuation for People Living with HIV in the US

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S534-S535
Author(s):  
Gerald Pierone ◽  
Jennifer S Fusco ◽  
Laurence Brunet ◽  
Cassidy Henegar ◽  
Jean A van Wyk ◽  
...  
Keyword(s):  
Viral Load ◽  
Board Member ◽  
Incidence Rates ◽  
People Living With Hiv ◽  
Open Circle ◽  
Viral Load Monitoring ◽  
The Us ◽  
Load Monitoring ◽  
Living With Hiv

Abstract Background The COVID-19 pandemic has disrupted health care services for people living with HIV (PLWH). This study aimed to compare rates of clinical visits, viral load monitoring and antiretroviral therapy (ART) regimen discontinuation among virally suppressed PLWH in the US before and during the COVID pandemic. Methods The study population consisted of ART-experienced PLWH ≥18 years of age and active in care in the OPERA cohort within 2 years prior to 31OCT2020. Virally suppressed PLWH (i.e., viral load < 200 copies/mL) were included if they switched to either dolutegravir/lamivudine or a dolutegravir- or bictegravir-based 3-drug regimen between 01MAY2019 and 30APR2020. The study periods spanned from 01MAY2019 to 28FEB2020 (pre-COVID) and 01MAR2020 to 31OCT2020 (during COVID). Incidence rates of clinical visits, viral load measurements and regimen discontinuation were estimated using univariate Poisson regression for both study periods. In-person visits comprised any scheduled or walk-in outpatient, inpatient, emergency or laboratory visit. Telehealth visits comprised any phone or video encounters. Results The study included 4806 PLWH in the pre-COVID and 4992 in the COVID period. Rates of in-person visits were reduced almost 2-fold during COVID, while telehealth visits increased almost 9-fold, resulting in an overall reduction in any visits rates from 10.07 visits per person-year (95% CI: 9.93, 10.21) pre-COVID to 7.10 (95% CI: 7.01, 7.19) during COVID [Fig 1]. Rates of viral load measurements dropped from 2.99 viral loads per person-year (95% CI: 2.92, 3.07) pre-COVID to 1.97 (95% CI: 1.92, 2.02) during COVID [Fig 2]. Regimen discontinuation rates were also reduced from 14.3 discontinuations per 100 person-years pre-COVID (95% CI: 12.7, 16.1) to 9.6 (95% CI: 8.6, 10.8) during COVID [Fig 3]. In both study periods, virologic failures were detected in < 1% of PLWH with ≥ 1 viral load. Figure 1. Incidence rates for overall, in-person, and telehealth visits during the pre-COVID (open circle) and the COVID (filled circle) study periods Incidence rates for viral load measurements during the pre-COVID (open circle) and the COVID (filled circle) study periods Incidence rates for regimen discontinuation during the pre-COVID (open circle) and the COVID (filled circle) study periods Conclusion The COVID pandemic has led to an important reduction in the frequency and type of clinical follow-up visits and viral load monitoring among virally suppressed PLWH in the US. A reduction in regimen discontinuation rates was also observed, presumably associated to less frequent follow-up. The long-term impact of the pandemic on HIV care remains uncertain. Disclosures Gerald Pierone, MD, Epividian (Board Member) Jennifer S. Fusco, BS, Epividian, inc (Employee) Laurence Brunet, PhD, Epividian, inc (Employee) Cassidy Henegar, PhD, GSK (Shareholder)ViiV Healthcare (Employee) Jean A. van Wyk, MB,ChB, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Supriya Sarkar, PhD, GSK (Shareholder)ViiV Healthcare (Employee) Vani Vannappagari, MBBS, MPH, PhD, ViiV Healthcare Limited (Employee) Andrew Zolopa, MD, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Michael B. Wohlfeiler, MD, Epividian, inc (Board Member)ViiV Healthcare (Research Grant or Support) Gregory Fusco, MD, MPH, Epividian, inc (Employee)

scholarly journals Long turnaround times in viral load monitoring of people living with HIV in resource-limited settings

2021 ◽  
Vol 0 (0) ◽  
pp. 0
Author(s):  
Fredrick Mbiva ◽  
Hannock Tweya ◽  
Srinath Satyanarayana ◽  
Kudakwashe Takarinda ◽  
Collins Timire ◽  
...  
Keyword(s):  
Viral Load ◽  
People Living With Hiv ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Viral Load Monitoring ◽  
Load Monitoring ◽  
Living With Hiv

scholarly journals Longitudinal Viral Load Monitoring Using Home-Collected Dried Blood Spot Specimens of MSM Living with HIV: Results from a Feasibility Pilot Study

2020 ◽  
Author(s):  
Richard A. Teran ◽  
Magdalena E. Sobieszczyk ◽  
Mary Ann Chiasson ◽  
Anne-Catrin Uhlemann ◽  
Jessica Weidler ◽  
...  
Keyword(s):  
Viral Load ◽  
Pilot Study ◽  
Dried Blood Spot ◽  
Viral Load Monitoring ◽  
Load Monitoring ◽  
Living With Hiv ◽  
Blood Spot

scholarly journals Feasibility of dried blood spots for HIV viral load monitoring in decentralized area in North Vietnam in a test-and-treat era, the MOVIDA project

PLoS ONE ◽  
2020 ◽  
Vol 15 (4) ◽  
pp. e0230968
Author(s):  
Tuan Anh Nguyen ◽  
Tram Hong Tran ◽  
Binh Thanh Nguyen ◽  
Tram Thi Phuong Pham ◽  
Nhung Thi Hong Le ◽  
...  
Keyword(s):  
Viral Load ◽  
Dried Blood Spots ◽  
Hiv Viral Load ◽  
Blood Spots ◽  
Test And Treat ◽  
Viral Load Monitoring ◽  
Load Monitoring ◽  
North Vietnam

scholarly journals Incidence of Herpes Zoster in HIV-Infected Patients Undergoing Antiretroviral Therapy: A Systematic Review and Meta-analysis

2021 ◽  
Vol 10 (11) ◽  
pp. 2300
Author(s):  
Han-Chang Ku ◽  
Yi-Tseng Tsai ◽  
Sriyani-Padmalatha Konara-Mudiyanselage ◽  
Yi-Lin Wu ◽  
Tsung Yu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Herpes Zoster ◽  
Antiretroviral Therapy ◽  
Random Effects ◽  
Meta Analysis ◽  
People Living With Hiv ◽  
Funnel Plots ◽  
Sex With Men ◽  
Treat All ◽  
Living With Hiv

The incidence of herpes zoster (HZ) in patients infected with HIV is higher than that of the general population. However, the incidence of HZ in HIV patients receiving antiretroviral therapy (ART) remains unclear. This meta-analysis aimed to estimate the pooled incidence rate and risk factors for HZ in the post-ART era. We identified studies assessing the incidence of HZ in the post-ART era between 1 January 2000 and 28 February 2021, from four databases. Pooled risk ratios were calculated from 11 articles using a random-effects model. The heterogeneity of the included trials was evaluated by visually inspecting funnel plots, performing random-effects meta-regression and using I2 statistics. Of the 2111 studies screened, we identified 11 studies that were eligible for final inclusion in the systematic review and 8 studies that were eligible for a meta-analysis. The pooled incidence of HZ in the post-ART era (after the introduction of ART in 1997) was 2.30 (95% confidence interval (CI): 1.56–3.05) per 100 person years (PYs). The risks of incidence of HZ among people living with HIV included male sex (AOR: 4.35 (95% CI: 054–2.41)), men who have sex with men (AOR: 1.21 (95% CI: −0.76–1.13)), CD4 count < 200 cells/μL (AOR: 11.59 (95% CI: 0.53–4.38)) and not receiving ART (AOR: 2.89 (95% CI: −0.44–2.56)). The incidence of HZ is substantially lower among HIV infected patients receiving ART than those not receiving ART. Initiating ART immediately after diagnosis to treat all HIV-positive individuals is crucial to minimize the disease burden of HZ.

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