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Home >> Publications >> Outcomes of antiretroviral treatment in programmes with and without routine viral load monitoring in Southern Africa.

Publication

Author(s):

Keiser O, Chi BH, Gsponer T, Boulle A, Orrell C, Phiri S, Maxwell N, Maskew M, Prozesky H, Fox MP, Westfall A, Egger M; IeDEA Southern Africa Collaboration.

Pub Title:

Outcomes of antiretroviral treatment in programmes with and without routine viral load monitoring in Southern Africa.

Pub Date:

Sep 10 2011

Pub Region(s):

Southern Africa

Journal Issue:

14

Page Number:
1761-9

Journal:

Title: 
AIDS
Link: 
http://journals.lww.com/aidsonline/pages/articleviewer.aspx?year=2011&issue=09100&article=00010&type=abstract

PubMed: 21681057
Pub PDF: PDF icon 21681057.pdf

Abstract
OBJECTIVES
: To compare outcomes of antiretroviral therapy (ART) in South Africa, where viral load monitoring is routine, with those in Malawi and Zambia, where monitoring is based on CD4 cell counts.

METHODS: We included 18,706 adult patients starting ART in South Africa and 80,937 patients in Zambia or Malawi. We examined CD4 responses in models for repeated measures and the probability of switching to second-line regimens, mortality and loss to follow-up in multistate models, measuring time from 6 months.

RESULTS: In South Africa, 9.8% [95% confidence interval (CI) 9.1-10.5] had switched at 3 years, 1.3% (95% CI 0.9-1.6) remained on failing first-line regimens, 9.2% (95% CI 8.5-9.8) were lost to follow-up and 4.3% (95% CI 3.9-4.8) had died. In Malawi and Zambia, more patients were on a failing first-line regimen [3.7% (95% CI 3.6-3.9], fewer patients had switched [2.1% (95% CI 2.0-2.3)] and more patients were lost to follow-up [15.3% (95% CI 15.0-15.6)] or had died [6.3% (95% CI 6.0-6.5)]. Median CD4 cell counts were lower in South Africa at the start of ART (93 vs. 132 cells/μl; P < 0.001) but higher after 3 years (425 vs. 383 cells/μl; P < 0.001). The hazard ratio comparing South Africa with Malawi and Zambia after adjusting for age, sex, first-line regimen and CD4 cell count was 0.58 (0.50-0.66) for death and 0.53 (0.48-0.58) for loss to follow-up.

CONCLUSION: Over 3 years of ART mortality was lower in South Africa than in Malawi or Zambia. The more favourable outcome in South Africa might be explained by viral load monitoring leading to earlier detection of treatment failure, adherence counselling and timelier switching to second-line ART.

PMID: 21681057 [PubMed - indexed for MEDLINE]

PMCID: PMC3605707

 

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Citation:

Keiser O, Chi BH, Gsponer T, Boulle A, Orrell C, Phiri S, Maxwell N, Maskew M, Prozesky H, Fox MP, Westfall A, Egger M; IeDEA Southern Africa Collaboration. Outcomes of antiretroviral treatment in programmes with and without routine viral load monitoring in Southern Africa. AIDS. 2011 Sep 10;25(14):1761-9. doi: 10.1097/QAD.0b013e328349822f. PubMed PMID: 21681057; PubMed Central PMCID: PMC3605707.