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Title: Long-term virological outcomes of first-line antiretroviral therapy for HIV-1 in low- and middle-income countries: A systematic review and meta-analysis
Authors: T. Sonia Boender
Kim C.E. Sigaloff
James H. Mcmahon
Sasisopin Kiertiburanakul
Michael R. Jordan
Jhoney Barcarolo
Nathan Ford
Tobias F. Rinke De Wit
Silvia Bertagnolio
University of Amsterdam
Academic Medical Centre, University of Amsterdam
Alfred Hospital
Tufts University
Mahidol University
Organisation Mondiale de la Sante
Keywords: Medicine
Issue Date: 1-Nov-2015
Citation: Clinical Infectious Diseases. Vol.61, No.9 (2015), 1453-1461
Abstract: © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. Background.More than 11.7 million people are currently receiving antiretroviral therapy (ART) in low- and middle-income countries (LMICs), and focused efforts are needed to ensure high levels of adherence and to minimize treatment failure. Recently, international targets have emphasized the importance of long-term virological suppression as a key measure of program performance. Methods.We systematically reviewed publications and conference abstracts published between January 2006 and May 2013 that reported virological outcomes among human immunodeficiency virus type 1 (HIV-1)-infected adults receiving first-line ART for up to 5 years in LMICs. Summary estimates of virological suppression after 6, 12, 24, 36, 48, and 60 months of ART were analyzed using random-effects meta-analysis. Intention-to-treat (ITT) analysis assumed all participants who were lost to follow-up, died, or stopped ART as having virological failure. Results.Summary estimates of virological suppression remained >80% for up to 60 months of ART for all 184 included cohorts. ITT analysis yielded 74.7% (95% confidence interval [CI], 72.2-77.2) suppression after 6 months and 61.8% (95% CI, 44.0-79.7) suppression after 48 months on ART. Switches to second-line ART were reported scarcely. Conclusions.Among individuals retained on ART, virological suppression rates during the first 5 years of ART were high (>80%) and stable. Suppression rates in ITT analysis declined during 4 years.
ISSN: 15376591
Appears in Collections:Scopus 2011-2015

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