scholarly journals Treatment as prevention in resource-limited settings: is it feasible to maintain HIV viral load suppression over time?

2013 ◽  
Vol 7 (08) ◽  
pp. 593-599
Author(s):  
María Eugenia Socías ◽  
Flavio Rotryng ◽  
Pablo Lapadula ◽  
Maira Medrano ◽  
Daniela Paz ◽  
...  
Keyword(s):  
Viral Load ◽  
Virologic Failure ◽  
Laboratory Data ◽  
Treatment As Prevention ◽  
Viral Load Suppression ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Third Line ◽  
Over Time

Introduction: Recently, there has been increasing interest in the role of “treatment as prevention” (TasP). Some of the questions regarding TasP strategies arise from the perceived difficulties in achieving and maintaining viral load (VL) suppression over time and the risk of emergence of viral resistance that could compromise future treatment options. This study was conducted to assess these questions in a resource-limited setting. Methodology: We performed a retrospective observational study of HIV-infected patients diagnosed in the pre-HAART era on follow-up at a private center from Buenos Aires, Argentina. Socio-demographic, clinical, and laboratory data were extracted from clinical charts. Analyses were performed to test for potential associations of selected variables with current virologic failure or use of third-line drugs. Results: Of 619 patients on follow-up, 82 (13.2%) were diagnosed in the pre-HAART era. At the time of our study, 79 (96.3%) patients were on HAART, with a median duration of 14 years (IQR 12–15) of therapy, and exposure to mono or dual nucleoside reverse transcriptase inhibitors regimens in 47.8% of cases. Sixty-nine patients (87.3%) had undetectable VL, 37 (46.8%) never presented virologic failure, and 19 (24.1%) experienced only one failure. Thirteen patients (16.5%) were receiving third-line ART regimens, with an average of 2.7-fold more virologic failures than those on first- or second-line regimens (p = 0.007). Conclusions:  Maintaining viral load suppression over time in resource-limited-settings is feasible.

scholarly journals Viral load care of HIV-1 infected children and adolescents: A longitudinal study in rural Zimbabwe

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245085
Author(s):  
Tichaona Mapangisana ◽  
Rhoderick Machekano ◽  
Vinie Kouamou ◽  
Caroline Maposhere ◽  
Kathy McCarty ◽  
...  
Keyword(s):  
Viral Load ◽  
Children And Adolescents ◽  
Virologic Failure ◽  
Sub Saharan Africa ◽  
Virologic Suppression ◽  
Second Line ◽  
Load Testing ◽  
Viral Load Suppression ◽  
Viral Load Testing

Introduction Maintaining virologic suppression of children and adolescents on ART in rural communities in sub-Saharan Africa is challenging. We explored switching drug regimens to protease inhibitor (PI) based treatment and reducing nevirapine and zidovudine use in a differentiated community service delivery model in rural Zimbabwe. Methods From 2016 through 2018, we followed 306 children and adolescents on ART in Hurungwe, Zimbabwe at Chidamoyo Christian Hospital, which provides compact ART regimens at 8 dispersed rural community outreach sites. Viral load testing was performed (2016) by Roche and at follow-up (2018) by a point of care viral load assay. Virologic failure was defined as viral load ≥1,000 copies/ml. A logistic regression model which included demographics, treatment regimens and caregiver’s characteristics was used to assess risks for virologic failure and loss to follow-up (LTFU). Results At baseline in 2016, 296 of 306 children and adolescents (97%) were on first-line ART, and only 10 were receiving a PI-based regimen. The median age was 12 years (IQR 8–15) and 55% were female. Two hundred and nine (68%) had viral load suppression (<1,000 copies/ml) and 97(32%) were unsuppressed (viral load ≥1000). At follow-up in 2018, 42/306 (14%) were either transferred 23 (7%) or LTFU 17 (6%) and 2 had died. In 2018, of the 264 retained in care, 107/264 (41%), had been switched to second-line, ritonavir-boosted PI with abacavir as a new nucleotide analog reverse transcriptase inhibitor (NRTI). Overall viral load suppression increased from 68% in 2016 to 81% in 2018 (P<0.001). Conclusion Viral load testing, and switching to second-line, ritonavir-boosted PI with abacavir significantly increased virologic suppression among HIV-infected children and adolescents in rural Zimbabwe.

scholarly journals Pharmacokinetic-pharmacodynamic modelling of atazanavir in hair among adolescents on antiretroviral treatment in Zimbabwe

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Bernard Ngara ◽  
Simbarashe Zvada ◽  
Tariro Dianah Chawana ◽  
Charles Fungai Brian Nhachi ◽  
Simbarashe Rusakaniko
Keyword(s):  
Viral Load ◽  
Secondary Analysis ◽  
Maximal Effect ◽  
Viral Load Suppression ◽  
Regression Methods ◽  
Pharmacodynamic Modelling ◽  
Pkpd Model ◽  
Drug Potency ◽  
Adherence Monitoring

Abstract Background Drug potency is a pharmacological parameter defining dose or concentration of drug required to obtain 50% of the drug’s maximal effect. Pharmacokinetic-pharmacodynamic modelling and simulation allows estimation of potency and evaluate strategies improving treatment outcome. The objective of our study is to determine potency of atazanavir in hair, defined as atazanavir level in hair associated with 50% probability of failing to achieve viral load below 1000 copies/ml among adolescents, and explore the effect of participant specific variables on potency. Methods A secondary analysis was performed on data from a previous study conducted in HIV-infected adolescents failing 2nd line ART from Harare central hospital, Zimbabwe, between 2015 and 2016. We simulated atazanavir concentrations in hair using NONMEM (version 7.3) ADVAN 13, based on a previously established pharmacokinetic model. Logistic regression methods were used for PKPD analysis. Simulations utilising PKPD model focused on estimation of potency and exploring the effect of covariates. Results The potency of atazanavir in hair was found to be 4.5 ng/mg hair before adjusting for covariate effects. Participants at three months follow-up, reporting adequate adherence, having normal BMI-for-age, and cared for by mature guardians had increased potency of atazanavir in hair of 2.6 ng/mg, however the follow-up event was the only statistically significant factor at 5% level. Conclusion Atazanavir in hair in the range 2.6 to 4.5 ng/mg is associated with above 50% probability of early viral load suppression. Adherence monitoring to adolescents with lower potency of atazanavir is recommended. The effect self-reported adherence level, BMI-for-age, and caregiver status require further evaluation.

scholarly journals 2504. Laboratory Evaluation of HIV-1 Viral Load Pooling with Marker-Assisted Deconvolution

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S868-S868
Author(s):  
Sabina Holland ◽  
Allison DeLong ◽  
Tao Liu ◽  
Anna Makaretz ◽  
Mia Coetzer ◽  
...  
Keyword(s):  
Viral Load ◽  
Virologic Failure ◽  
Low Cost ◽  
Clinical Information ◽  
Laboratory Evaluation ◽  
Clinical Markers ◽  
First Line Therapy ◽  
Resource Limited ◽  
Hiv 1

Abstract Background Cost still limits HIV-1 viral load (VL) routine monitoring in resource limited settings (RLS), preventing early detection of virologic failure (VF). Pooled VL testing reduces cost over individual testing (IND). We previously showed in simulation, that additional cost benefits over previously-used pooling deconvolution algorithms can be achieved by using low-cost, routinely-collected clinical markers to determine the order for VL testing in deconvolution (termed marker-assisted minipool plus algorithm; mMPA). This algorithm has not been assessed in-vitro. Methods 150 samples from 99 Ghanaian adults with HIV on first-line therapy (VF 17%; CD4-VL correlation −0.35) were used to construct 30, 5-sample pools: n = 10 with 0, n = 5 with 1, and n = 15 with 2 individuals with VF. VL testing was with Abbott M2000. Accuracy, number of tests and rounds of testing to deconvolute pools were estimated using four strategies: (1) IND; (2) Minipooling (MP); (3) Minipooling with algorithm (MPA); and (4) mMPA. Results Compared with IND, MP and MPA, mMPA reduced total number of tests per pool needed to ascertain VF: MP average 4.3 (95% confidence interval (CI) 3.5–5.2, p> 0.05), MPA 3.0 (95% CI 2.4–3.5, P < 0.001), and mMPA 2.5 (CI 2.0–3.0, P < 0.001). Compared with MP and MPA, mMPA further reduced VL tests by 42% (1.9 tests/pool, CI 1.3–2.4, P < 0.001) and 17% (0.5, CI 0.2–0.8, p = 0.004); and required fewer testing rounds than MPA by 17% (P < 0.01), thus producing results quicker. IND and MP had 100% sensitivity and specificity. MPA and mMPA had similar sensitivity of 96.1% (MPA CI 90.7–100%; mMPA CI 88.0–100.0%) and specificity of 99.5% and 99.2% (98.5–100.0% for MPA and 97.5–100.0% for mMPA). Specifically, 3/150 samples were misclassified with MPA and mMPA: one suppression as VF, and two VF as suppressed. Conclusion Laboratory evaluation confirms that deconvolution using mMPA with CD4 or other routinely-collected clinical information as low-cost biomarkers reduces the number of VL assays required to identify VF in a setting with a low prevalence of VF. Implementation of pooled VL testing using mMPA for deconvolution may increase the availability of VL monitoring in RLS. Work is ongoing to reduce complexity and misclassification, required prior to widespread implementation. Disclosures All authors: No reported disclosures.

scholarly journals Selecting a viral load threshold for routine monitoring in resource-limited settings: optimizing individual health and population impact

2017 ◽  
Vol 20 ◽  
pp. e25007 ◽  
Author(s):  
Tanya M Ellman ◽  
Bereket Alemayehu ◽  
Elaine J Abrams ◽  
Stephen Arpadi ◽  
Andrea A Howard ◽  
...  
Keyword(s):  
Viral Load ◽  
Resource Limited Settings ◽  
Population Impact ◽  
Individual Health ◽  
Resource Limited ◽  
Routine Monitoring

scholarly journals Short-term effectiveness of HIV care coordination among persons with recent HIV diagnosis or history of poor HIV outcomes

2018 ◽  
Author(s):  
Denis Nash ◽  
McKaylee M. Robertson ◽  
Kate Penrose ◽  
Stephanie Chamberlin ◽  
Rebekkah S. Robbins ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Viral Load ◽  
Relative Risk ◽  
York City ◽  
Hiv Care ◽  
Newly Diagnosed ◽  
Viral Load Suppression ◽  
History Of

AbstractThe New York City HIV Care Coordination Program (CCP) combines multiple evidence-based strategies to support persons living with HIV (PLWH) at risk for, or with a recent history of, poor HIV outcomes. We assessed the comparative effectiveness of the CCP by merging programmatic data on CCP clients with population-based surveillance data on all New York City PLWH. A non-CCP comparison group of similar PLWH who met CCP eligibility criteria was identified using surveillance data. The CCP and non-CCP groups were matched on propensity for CCP enrollment within four baseline treatment status groups (newly diagnosed or previously diagnosed and either consistently unsuppressed, inconsistently suppressed or consistently suppressed). We compared CCP to non-CCP proportions with viral load suppression at 12-month follow-up. Among the 13,624 persons included, 15·3% were newly diagnosed; among the 84·7% previously diagnosed, 14·2% were consistently suppressed, 28·9% were inconsistently suppressed, and 41 ·6% were consistently unsuppressed in the year prior to baseline. At 12-month follow-up, 59·9% of CCP and 53·9% of non-CCP participants had viral load suppression (Relative Risk=1.11, 95%CI:1.08-1.14). Among those newly diagnosed and those consistently unsuppressed at baseline, the relative risk of viral load suppression in the CCP versus non-CCP participants was 1.15 (95%CI:1.09-1.23) and 1.32 (95%CI:1.23-1.42), respectively. CCP exposure shows benefits over no CCP exposure for persons newly diagnosed or consistently unsuppressed, but not for persons suppressed in the year prior to baseline. We recommend more targeted case finding for CCP enrollment and increased attention to viral load suppression maintenance.

Sign in / Sign up

Export Citation Format

Share Document