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Determining virological suppression and resuppression by point-of-care viral load testing in a HIV care setting in sub-Saharan Africa
BACKGROUND: This prospective pilot study explored same-day point-of-care viral load testing in a setting in Ghana that has yet to implement virological monitoring of antiretroviral therapy (ART). METHODS: Consecutive patients accessing outpatient care while on ART underwent HIV-1 RNA quantification...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6948257/ https://www.ncbi.nlm.nih.gov/pubmed/31922120 http://dx.doi.org/10.1016/j.eclinm.2019.12.001 |
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author | Villa, Giovanni Abdullahi, Adam Owusu, Dorcas Smith, Colette Azumah, Marilyn Sayeed, Laila Austin, Harrison Awuah, Dominic Beloukas, Apostolos Chadwick, David Phillips, Richard Geretti, Anna Maria |
author_facet | Villa, Giovanni Abdullahi, Adam Owusu, Dorcas Smith, Colette Azumah, Marilyn Sayeed, Laila Austin, Harrison Awuah, Dominic Beloukas, Apostolos Chadwick, David Phillips, Richard Geretti, Anna Maria |
author_sort | Villa, Giovanni |
collection | PubMed |
description | BACKGROUND: This prospective pilot study explored same-day point-of-care viral load testing in a setting in Ghana that has yet to implement virological monitoring of antiretroviral therapy (ART). METHODS: Consecutive patients accessing outpatient care while on ART underwent HIV-1 RNA quantification by Xpert. Those with viraemia at the first measurement (T0) received immediate adherence counselling and were reassessed 8 weeks later (T1). Predictors of virological status were determined by logistic regression analysis. Drug resistance-associated mutations (RAMs) were detected by Sanger sequencing. FINDINGS: At T0, participants had received treatment for a median of 8·9 years; 297/333 (89·2%) were on NNRTI-based ART. The viral load was ≥40 copies/mL in 164/333 (49·2%) patients and ≥1000 copies/mL in 71/333 (21·3%). In the latter group, 50/65 (76·9%) and 55/65 (84·6%) harboured NRTI and NNRTI RAMs, respectively, and 27/65 (41·5%) had ≥1 tenofovir RAM. Among 150/164 (91·5%) viraemic patients that reattended at T1, 32/150 (21·3%) showed resuppression <40 copies/mL, comprising 1/65 (1·5%) subjects with T0 viral load ≥1000 copies/mL and 31/85 (36·5%) subjects with lower levels. A T0 viral load ≥1000 copies/mL and detection of RAMs predicted ongoing T1 viraemia independently of self-reported adherence levels. Among participants with T0 viral load ≥1000 copies/mL, 23/65 (35·4%) showed resuppression <1000 copies/mL; the response was more likely among those with higher adherence levels and no RAMs. INTERPRETATION: Same-day point-of-care viral load testing was feasible and revealed poor virological control and suboptimal resuppression rates despite adherence counselling. Controlled studies should determine optimal triaging modalities for same-day versus deferred viral load testing. FUNDING: University of Liverpool, South Tees Infectious Diseases Research Fund |
format | Online Article Text |
id | pubmed-6948257 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-69482572020-01-09 Determining virological suppression and resuppression by point-of-care viral load testing in a HIV care setting in sub-Saharan Africa Villa, Giovanni Abdullahi, Adam Owusu, Dorcas Smith, Colette Azumah, Marilyn Sayeed, Laila Austin, Harrison Awuah, Dominic Beloukas, Apostolos Chadwick, David Phillips, Richard Geretti, Anna Maria EClinicalMedicine Research paper BACKGROUND: This prospective pilot study explored same-day point-of-care viral load testing in a setting in Ghana that has yet to implement virological monitoring of antiretroviral therapy (ART). METHODS: Consecutive patients accessing outpatient care while on ART underwent HIV-1 RNA quantification by Xpert. Those with viraemia at the first measurement (T0) received immediate adherence counselling and were reassessed 8 weeks later (T1). Predictors of virological status were determined by logistic regression analysis. Drug resistance-associated mutations (RAMs) were detected by Sanger sequencing. FINDINGS: At T0, participants had received treatment for a median of 8·9 years; 297/333 (89·2%) were on NNRTI-based ART. The viral load was ≥40 copies/mL in 164/333 (49·2%) patients and ≥1000 copies/mL in 71/333 (21·3%). In the latter group, 50/65 (76·9%) and 55/65 (84·6%) harboured NRTI and NNRTI RAMs, respectively, and 27/65 (41·5%) had ≥1 tenofovir RAM. Among 150/164 (91·5%) viraemic patients that reattended at T1, 32/150 (21·3%) showed resuppression <40 copies/mL, comprising 1/65 (1·5%) subjects with T0 viral load ≥1000 copies/mL and 31/85 (36·5%) subjects with lower levels. A T0 viral load ≥1000 copies/mL and detection of RAMs predicted ongoing T1 viraemia independently of self-reported adherence levels. Among participants with T0 viral load ≥1000 copies/mL, 23/65 (35·4%) showed resuppression <1000 copies/mL; the response was more likely among those with higher adherence levels and no RAMs. INTERPRETATION: Same-day point-of-care viral load testing was feasible and revealed poor virological control and suboptimal resuppression rates despite adherence counselling. Controlled studies should determine optimal triaging modalities for same-day versus deferred viral load testing. FUNDING: University of Liverpool, South Tees Infectious Diseases Research Fund Elsevier 2020-01-05 /pmc/articles/PMC6948257/ /pubmed/31922120 http://dx.doi.org/10.1016/j.eclinm.2019.12.001 Text en © 2019 Published by Elsevier Ltd. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Research paper Villa, Giovanni Abdullahi, Adam Owusu, Dorcas Smith, Colette Azumah, Marilyn Sayeed, Laila Austin, Harrison Awuah, Dominic Beloukas, Apostolos Chadwick, David Phillips, Richard Geretti, Anna Maria Determining virological suppression and resuppression by point-of-care viral load testing in a HIV care setting in sub-Saharan Africa |
title | Determining virological suppression and resuppression by point-of-care viral load testing in a HIV care setting in sub-Saharan Africa |
title_full | Determining virological suppression and resuppression by point-of-care viral load testing in a HIV care setting in sub-Saharan Africa |
title_fullStr | Determining virological suppression and resuppression by point-of-care viral load testing in a HIV care setting in sub-Saharan Africa |
title_full_unstemmed | Determining virological suppression and resuppression by point-of-care viral load testing in a HIV care setting in sub-Saharan Africa |
title_short | Determining virological suppression and resuppression by point-of-care viral load testing in a HIV care setting in sub-Saharan Africa |
title_sort | determining virological suppression and resuppression by point-of-care viral load testing in a hiv care setting in sub-saharan africa |
topic | Research paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6948257/ https://www.ncbi.nlm.nih.gov/pubmed/31922120 http://dx.doi.org/10.1016/j.eclinm.2019.12.001 |
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