Results of early virologic monitoring may facilitate differentiated care monitoring strategies for clients on ART, Rakai, Uganda

Post Date: 
2018-10-15
   |   
Countries: 
Publication: 
Open Forum Infectious Diseases
Summary: 

BACKGROUND:
Viral load (VL) monitoring is standard of care in HIV-infected persons initiated on antiretroviral therapy (ART). We evaluated the predictive value of VL measurements at 6 and 12 months after initiation of firstline ART to estimate the future risk of virologic failure (VF).

METHODS:
HIV-infected persons with VL measurements at 6 and 12 months post-ART initiation and at least 2 additional VL measurements thereafter were assessed for risk of future VF, defined per World Health Organization guidelines. VL at 6 or 12 months post-ART was categorized into <400, 400-1000, 1001-2000, and >2000 copies/mL. Cox proportional hazard models were used to compare VF incidence associated with 6-month, 12-month, and a composite of 6- and 12-month VL prediction indicators.

RESULTS:
Overall, 1863 HIV-infected adults had a 6- and 12-month VL measurement, and 1588 had at least 2 additional VLs thereafter for predicting future VF. The majority (67%) were female (median age: females 33 years and males 37 years). At 12 months post-ART, 90% had VL<400 copies/mL (cumulative incidence of VF at 1.5%), 3% had 400-1000 copies/mL (VF 12%), 2% had 1001-2000 copies/mL (VF 22%), and 5% had >2000 copies/mL (VF 71%). The predictive value of the 12-month VL measurement was comparable to the composite of both the 6- and 12-month VL measurements and better than the 6-month VL measurement.

CONCLUSIONS:
At 12 months after ART initiation, 90% of patients were virally suppressed with a low likelihood of future VF. VL measurement at 12 months post-ART initiation predicts risk of VF and could inform differentiated virologic monitoring strategies.

Citation: 
Ssempijja V, Chang LW, Nakigozi G, Ndyanabo A, Quinn TC, Cobelens F, Wawer M, Gray R, Serwadda D, Reynolds SJ. Results of early virologic monitoring may facilitate differentiated care monitoring strategies for clients on ART, Rakai, Uganda. Open Forum Infect Dis. 2018 Oct 9;5(10):ofy212. doi: 10.1093/ofid/ofy212. eCollection 2018 Oct. PMID: 30320148; PMCID: PMC6176337.
Collaborators: 
  • Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, MD
  • Rakai Health Sciences Program, Kalisizo, Uganda
  • Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
  • Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
  • Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
  • Makerere University School of Public Health, Kampala, Uganda