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J Acquir Immune Defic Syndr. 2013 Sep 1;64(1):74-8. doi: 10.1097/QAI.0b013e31829f05ac.

Viral load monitoring as a tool to reinforce adherence: a systematic review.

Author information

1
Access Campaign, Médecins Sans Frontières, Geneva, Switzerland. Kimberly.bonner@geneva.msf.org

Abstract

OBJECTIVE:

Viral load monitoring has been proposed as a tool to reinforce adherence, but outcomes have never been systematically assessed.

DESIGN:

A meta-analysis was conducted to systematically analyze the research on viral load monitoring as a tool to reinforce adherence. Viremic resuppression is defined here as a decrease in viral load beneath a particular threshold following viral load levels that have been elevated despite antiretroviral treatment.

METHODS:

Six databases were searched for studies published up to November 2012, which reported the use of viral load monitoring as a tool to identify patients in need of adherence support. Three conference abstract sites were reviewed for studies reported in the last 2 years. Randomized and quasi-randomized trials and observational studies, were eligible. No language or geographical restrictions were applied.

RESULTS:

Six retrospective and 2 prospective observational studies reported data from 8 countries: South Africa, the United States, Thailand, Mali, Burkina Faso, Swaziland, India, and France. Five studies reported on viremic resuppression, with a pooled estimate of 70.5% (95% confidence interval: 56.6% to 84.4%) resuppressed. The remaining 3 studies all reported declines in mean viral load. Delayed onset of routine viral load monitoring was associated with the emergence of drug resistance.

CONCLUSIONS:

The clear trend of resuppression, following viral load testing and adherence support, demonstrates the utility of viral load as a tool to identify patients in need of enhanced adherence support.

PMID:
23774877
DOI:
10.1097/QAI.0b013e31829f05ac
[Indexed for MEDLINE]

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