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J Acquir Immune Defic Syndr. 2017 Nov 1;76(3):319-329. doi: 10.1097/QAI.0000000000001499.

HIV Viral Load Suppression in Adults and Children Receiving Antiretroviral Therapy-Results From the IeDEA Collaboration.

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1
*The Kirby Institute, UNSW, Sydney, New South Wales, Australia; †Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; ‡Fundacion Huesped, Buenos Aires, Argentina; §University of Chile School of Medicine & Fundación Arriaran, Santiago, Chile; ‖School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; ¶Children's Hospital 2, Ho Chi Minh City, Vietnam; #Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; **University of Calgary, Calgary, Alberta, Canada; ††YRGCARE Medical Centre, Chennai, India; ‡‡Pediatric Infectious Disease Division, Escola Paulista de Medicina-Universidade Federal de SãoPaulo, São Paulo, Brazil; §§Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD; ‖‖Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; and ¶¶Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

Abstract

BACKGROUND:

Having 90% of patients on antiretroviral therapy (ART) and achieving an undetectable viral load (VL) is 1 of the 90:90:90 by 2020 targets. In this global analysis, we investigated the proportions of adult and paediatric patients with VL suppression in the first 3 years after ART initiation.

METHODS:

Patients from the IeDEA cohorts who initiated ART between 2010 and 2014 were included. Proportions with VL suppression (<1000 copies/mL) were estimated using (1) strict intention to treat (ITT)-loss to follow-up (LTFU) and dead patients counted as having detectable VL; and (2) modified ITT-LTFU and dead patients were excluded. Logistic regression was used to identify predictors of viral suppression at 1 year after ART initiation using modified ITT.

RESULTS:

A total of 35,561 adults from 38 sites/16 countries and 2601 children from 18 sites/6 countries were included. When comparing strict with modified ITT methods, the proportion achieving VL suppression at 3 years from ART initiation changed from 45.1% to 90.2% in adults, and 60.6% to 80.4% in children. In adults, older age, higher CD4 count pre-ART, and homosexual/bisexual HIV exposure were associated with VL suppression. In children, older age and higher CD4 percentage pre-ART showed significant associations with VL suppression.

CONCLUSIONS:

Large increases in the proportion of VL suppression in adults were observed when we excluded those who were LTFU or had died. The increases were less pronounced in children. Greater emphasis should be made to minimize LTFU and maximize patient retention in HIV-infected patients of all age groups.

PMID:
28708808
PMCID:
PMC5634924
DOI:
10.1097/QAI.0000000000001499
[Indexed for MEDLINE]
Free PMC Article

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