Virological failure and treatment switch after ART initiation among people living with HIV with and without routine viral load monitoring in Asia
Issued Date
2022-08-01
Resource Type
eISSN
17582652
Scopus ID
2-s2.0-85136970210
Journal Title
Journal of the International AIDS Society
Volume
25
Issue
8
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of the International AIDS Society Vol.25 No.8 (2022)
Suggested Citation
Teeraananchai S., Law M., Boettiger D., Mata N.D.L., Gupte N., Chan Y.t.L., Pham T.N., Chaiwarith R., Ly P.S., Chan Y.J., Kiertiburanakul S., Khusuwan S., Zhang F., Yunihastuti E., Kumarasamy N., Pujari S., Azwa I., Somia I.K.A., Tanuma J., Ditangco R., Choi J.Y., Ng O.T., Do C.D., Gani Y., Ross J., Jiamsakul A. Virological failure and treatment switch after ART initiation among people living with HIV with and without routine viral load monitoring in Asia. Journal of the International AIDS Society Vol.25 No.8 (2022). doi:10.1002/jia2.25989 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85646
Title
Virological failure and treatment switch after ART initiation among people living with HIV with and without routine viral load monitoring in Asia
Author's Affiliation
Ramathibodi Hospital
Hospital Sungai Buloh
The University of Sydney School of Public Health
Beijing Ditan Hospital Capital Medical University
VHS Medical Centre India
Gokila
Bach Mai Hospital
Universitas Udayana
Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo
Faculty of Medicine, Chiang Mai University
The Kirby Institute
National Center for Global Health and Medicine
Kasetsart University
The HIV Netherlands Australia Thailand Research Collaboration
Yonsei University College of Medicine
Queen Elizabeth Hospital Hong Kong
University of Malaya Medical Centre
Veterans General Hospital-Taipei
Tan Tock Seng Hospital
Chiang Mai University
BJ Government Medical College and Sassoon General Hospital
National Hospital for Tropical Diseases
National Center for HIV/AIDS
amfAR - The Foundation for AIDS Research
Institute of Infectious Diseases
Chiangrai Prachanukroh Hospital
Hospital Sungai Buloh
The University of Sydney School of Public Health
Beijing Ditan Hospital Capital Medical University
VHS Medical Centre India
Gokila
Bach Mai Hospital
Universitas Udayana
Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo
Faculty of Medicine, Chiang Mai University
The Kirby Institute
National Center for Global Health and Medicine
Kasetsart University
The HIV Netherlands Australia Thailand Research Collaboration
Yonsei University College of Medicine
Queen Elizabeth Hospital Hong Kong
University of Malaya Medical Centre
Veterans General Hospital-Taipei
Tan Tock Seng Hospital
Chiang Mai University
BJ Government Medical College and Sassoon General Hospital
National Hospital for Tropical Diseases
National Center for HIV/AIDS
amfAR - The Foundation for AIDS Research
Institute of Infectious Diseases
Chiangrai Prachanukroh Hospital
Other Contributor(s)
Abstract
Introduction: Viral load (VL) testing is still challenging to monitor treatment responses of antiretroviral therapy (ART) for HIV treatment programme in Asia. We assessed the association between routine VL testing and virological failure (VF) and determine factors associated with switching to second-line regimen. Methods: Among 21 sites from the TREAT Asia HIV Observational Database (TAHOD), people living with HIV (PLHIV) aged ≥18 years initiating ART from 2003 to 2021 were included. We calculated the average number of VL tests per patient per year between the date of ART initiation and the most recent visit. If the median average number of VL tests was ≥ 0.80 per patient per year, the site was classified as a routine VL site. A site with a median < 0.80 was classified into the non-routine VL sites. VF was defined as VL ≥1000 copies/ml during first-line therapy. Factors associated with VF were analysed using generalized estimating equations with Poisson distribution. Results: Of 6277 PLHIV starting ART after 2003, 3030 (48%) were from 11 routine VL testing sites and 3247 (52%) were from 10 non-routine VL testing sites. The median follow-up was 9 years (IQR 5–13). The median age was 35 (30–42) years; 68% were male and 5729 (91%) started non-nucleoside reverse-transcriptase inhibitor-based regimen. The median pre-ART CD4 count in PLHIV from routine VL sites was lower compared to non-routine VL sites (144 vs. 156 cells/mm3, p <0.001). Overall, 1021 subsequent VF at a rate of 2.15 (95% CI 2.02–2.29) per 100 person-years (PY). VF was more frequent at non-routine VL sites (adjusted incidence rate ratio 2.85 [95% CI 2.27–3.59]) compared to routine VL sites. Other factors associated with an increased rate of VF were age <50 years and CD4 count <350 cells/mm3. A total of 817 (13%) patients switched to second-line regimen at a rate of 1.44 (95% CI 1.35–1.54) per 100 PY. PLHIV at routine VL monitoring sites were at higher risk of switching than those at non-routine VL sites (adjusted sub-hazard ratio 1.78 95% CI [1.17–2.71]). Conclusions: PLHIV from non-routine VL sites had a higher incidence of persistent VF and a low switching regimen rate, reflecting possible under-utilized VL testing.