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Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis

BACKGROUND: Progress toward the global target for 95% virological suppression among those on antiretroviral treatment (ART) is still suboptimal. We describe the viral load (VL) cascade, the incidence of virological failure and associated risk factors among people living with HIV receiving first-line...

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Autores principales: Mesic, Anita, Spina, Alexander, Mar, Htay Thet, Thit, Phone, Decroo, Tom, Lenglet, Annick, Thandar, Moe Pyae, Thwe, Thin Thin, Kyaw, Aung Aung, Homan, Tobias, Sangma, Mitchell, Kremer, Ronald, Grieg, Jane, Piriou, Erwan, Ritmeijer, Koert, Van Olmen, Josefien, Lynen, Lutgarde, Oo, Htun Nyunt
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8059266/
https://www.ncbi.nlm.nih.gov/pubmed/33882962
http://dx.doi.org/10.1186/s12981-021-00336-0
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author Mesic, Anita
Spina, Alexander
Mar, Htay Thet
Thit, Phone
Decroo, Tom
Lenglet, Annick
Thandar, Moe Pyae
Thwe, Thin Thin
Kyaw, Aung Aung
Homan, Tobias
Sangma, Mitchell
Kremer, Ronald
Grieg, Jane
Piriou, Erwan
Ritmeijer, Koert
Van Olmen, Josefien
Lynen, Lutgarde
Oo, Htun Nyunt
author_facet Mesic, Anita
Spina, Alexander
Mar, Htay Thet
Thit, Phone
Decroo, Tom
Lenglet, Annick
Thandar, Moe Pyae
Thwe, Thin Thin
Kyaw, Aung Aung
Homan, Tobias
Sangma, Mitchell
Kremer, Ronald
Grieg, Jane
Piriou, Erwan
Ritmeijer, Koert
Van Olmen, Josefien
Lynen, Lutgarde
Oo, Htun Nyunt
author_sort Mesic, Anita
collection PubMed
description BACKGROUND: Progress toward the global target for 95% virological suppression among those on antiretroviral treatment (ART) is still suboptimal. We describe the viral load (VL) cascade, the incidence of virological failure and associated risk factors among people living with HIV receiving first-line ART in an HIV cohort in Myanmar treated by the Médecins Sans Frontières in collaboration with the Ministry of Health and Sports Myanmar. METHODS: We conducted a retrospective cohort study, including adult patients with at least one HIV viral load test result and having received of at least 6 months’ standard first-line ART. The incidence rate of virological failure (HIV viral load ≥ 1000 copies/mL) was calculated. Multivariable Cox’s regression was performed to identify risk factors for virological failure. RESULTS: We included 25,260 patients with a median age of 33.1 years (interquartile range, IQR 28.0–39.1) and a median observation time of 5.4 years (IQR 3.7–7.9). Virological failure was documented in 3,579 (14.2%) participants, resulting in an overall incidence rate for failure of 2.5 per 100 person-years of follow-up. Among those who had a follow-up viral load result, 1,258 (57.1%) had confirmed virological failure, of which 836 (66.5%) were switched to second-line treatment. An increased hazard for failure was associated with age ≤ 19 years (adjusted hazard ratio, aHR 1.51; 95% confidence intervals, CI 1.20–1.89; p < 0.001), baseline tuberculosis (aHR 1.39; 95% CI 1.14–1.49; p < 0.001), a history of low-level viremia (aHR 1.60; 95% CI 1.42–1.81; p < 0.001), or a history of loss-to-follow-up (aHR 1.24; 95% CI 1.41–1.52; p = 0.041) and being on the same regimen (aHR 1.37; 95% CI 1.07–1.76; p < 0.001). Cumulative appointment delay was not significantly associated with failure after controlling for covariates. CONCLUSIONS: VL monitoring is an important tool to improve programme outcomes, however limited coverage of VL testing and acting on test results hampers its full potential. In our cohort children and adolescents, PLHIV with history of loss-to-follow-up or those with low-viremia are at the highest risk of virological failure and might require more frequent virological monitoring than is currently recommended. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12981-021-00336-0.
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spelling pubmed-80592662021-04-21 Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis Mesic, Anita Spina, Alexander Mar, Htay Thet Thit, Phone Decroo, Tom Lenglet, Annick Thandar, Moe Pyae Thwe, Thin Thin Kyaw, Aung Aung Homan, Tobias Sangma, Mitchell Kremer, Ronald Grieg, Jane Piriou, Erwan Ritmeijer, Koert Van Olmen, Josefien Lynen, Lutgarde Oo, Htun Nyunt AIDS Res Ther Research BACKGROUND: Progress toward the global target for 95% virological suppression among those on antiretroviral treatment (ART) is still suboptimal. We describe the viral load (VL) cascade, the incidence of virological failure and associated risk factors among people living with HIV receiving first-line ART in an HIV cohort in Myanmar treated by the Médecins Sans Frontières in collaboration with the Ministry of Health and Sports Myanmar. METHODS: We conducted a retrospective cohort study, including adult patients with at least one HIV viral load test result and having received of at least 6 months’ standard first-line ART. The incidence rate of virological failure (HIV viral load ≥ 1000 copies/mL) was calculated. Multivariable Cox’s regression was performed to identify risk factors for virological failure. RESULTS: We included 25,260 patients with a median age of 33.1 years (interquartile range, IQR 28.0–39.1) and a median observation time of 5.4 years (IQR 3.7–7.9). Virological failure was documented in 3,579 (14.2%) participants, resulting in an overall incidence rate for failure of 2.5 per 100 person-years of follow-up. Among those who had a follow-up viral load result, 1,258 (57.1%) had confirmed virological failure, of which 836 (66.5%) were switched to second-line treatment. An increased hazard for failure was associated with age ≤ 19 years (adjusted hazard ratio, aHR 1.51; 95% confidence intervals, CI 1.20–1.89; p < 0.001), baseline tuberculosis (aHR 1.39; 95% CI 1.14–1.49; p < 0.001), a history of low-level viremia (aHR 1.60; 95% CI 1.42–1.81; p < 0.001), or a history of loss-to-follow-up (aHR 1.24; 95% CI 1.41–1.52; p = 0.041) and being on the same regimen (aHR 1.37; 95% CI 1.07–1.76; p < 0.001). Cumulative appointment delay was not significantly associated with failure after controlling for covariates. CONCLUSIONS: VL monitoring is an important tool to improve programme outcomes, however limited coverage of VL testing and acting on test results hampers its full potential. In our cohort children and adolescents, PLHIV with history of loss-to-follow-up or those with low-viremia are at the highest risk of virological failure and might require more frequent virological monitoring than is currently recommended. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12981-021-00336-0. BioMed Central 2021-04-21 /pmc/articles/PMC8059266/ /pubmed/33882962 http://dx.doi.org/10.1186/s12981-021-00336-0 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Mesic, Anita
Spina, Alexander
Mar, Htay Thet
Thit, Phone
Decroo, Tom
Lenglet, Annick
Thandar, Moe Pyae
Thwe, Thin Thin
Kyaw, Aung Aung
Homan, Tobias
Sangma, Mitchell
Kremer, Ronald
Grieg, Jane
Piriou, Erwan
Ritmeijer, Koert
Van Olmen, Josefien
Lynen, Lutgarde
Oo, Htun Nyunt
Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis
title Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis
title_full Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis
title_fullStr Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis
title_full_unstemmed Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis
title_short Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis
title_sort predictors of virological failure among people living with hiv receiving first line antiretroviral treatment in myanmar: retrospective cohort analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8059266/
https://www.ncbi.nlm.nih.gov/pubmed/33882962
http://dx.doi.org/10.1186/s12981-021-00336-0
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