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Publication

Author(s):

Belaunzarán-Zamudio PF, Caro-Vega YN, Shepherd BE, Crabtree-Ramírez BE, Luz PM, Grinsztejn B, Cesar C, Cahn P, Cortés C, Wolff M, Pape JW, Padgett D, Gotuzzo E, McGowan C, Sierra-Madero JG; CCASAnet.

Pub Title:

Monitoring of HIV treatment in seven countries in the WHO Region of the Americas.

Pub Date:

Aug 1 2015

Page Number:
529-39

Journal:

Title: 
Bull World Health Organ
Link: 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4581655/

PubMed: 26478610

OBJECTIVE:

To determine the prevalence of adequate monitoring and the costs of measuring CD4+ T-lymphocytes (CD4+ cell) and human immunodeficiency virus (HIV) viral load in people receiving antiretroviral therapy (ART) in seven countries in the WHO Region of the Americas.

METHODS:

We obtained retrospective, longitudinal data for 14 476 adults who started a first ART regimen at seven HIV clinics in Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru between 2000 and 2011. We estimated the proportion of 180-day periods with adequate monitoring, which we defined as at least one CD4+ cell count and one viral load measurement. Factors associated with adequate monitoring were analysed using regression methods. The costs of the tests were estimated.

FINDINGS:

The median follow-up time was 50.4 months; the proportion of 180-day periods with adequate CD4+ cell counts was 69% while the proportion with adequate monitoring was 62%. Adequate monitoring was more likely in participants who were older, who started ART more recently, whose first regimen included a non-nucleoside reverse transcriptase inhibitor or who had a CD4+ cell count less than 200 cells/µl at ART initiation. The cost of one CD4+ cell count ranged from 7.37 United States dollars (US$) in Argentina to US$ 64.09 in Chile; the cost of one viral load measurement ranged from US$ 20.34 in Brazil to US$ 186.28 in Haiti.

CONCLUSION:

In HIV-infected participants receiving ART in the WHO Region of the Americas, CD4+ cell count and viral load monitoring was often carried out less frequently than regional guidelines recommend. The laboratory costs of monitoring varied greatly.

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Citation:

Belaunzarán-Zamudio PF, Caro-Vega YN, Shepherd BE, Crabtree-Ramírez BE, Luz PM, Grinsztejn B, Cesar C, Cahn P, Cortés C, Wolff M, Pape JW, Padgett D, Gotuzzo E, McGowan C, Sierra-Madero JG; CCASAnet. Monitoring of HIV treatment in seven countries in the WHO Region of the Americas. Bull World Health Organ. 2015 Aug 1;93(8):529-39. doi: 10.2471/BLT.14.147447. Epub 2015 May 27. PubMed PMID: 26478610; PubMed Central PMCID: PMC4581655.