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Home >> Publications >> Viral load versus CD4⁺ monitoring and 5-year outcomes of antiretroviral therapy in HIV-positive children in Southern Africa: a cohort-based modelling study.

Publication

Author(s):

Salazar-Vizcaya L, Keiser O, Karl Technau, Davies MA, Haas AD, Blaser N, Cox V, Eley B, Rabie H, Moultrie H, Giddy J, Wood R, Egger M, Estill J.

Pub Title:

Viral load versus CD4⁺ monitoring and 5-year outcomes of antiretroviral therapy in HIV-positive children in Southern Africa: a cohort-based modelling study.

Pub Date:

Dec 10 2014

Pub Region(s):

Southern Africa

Journal:

Title: 
AIDS
Link: 
http://ovidsp.tx.ovid.com/sp-3.13.1a/ovidweb.cgi?QS2=434f4e1a73d37e8c3b61fcc465cfeaf2a898ce192a9d144f7db11b47749c5d9354a0f5c1702f0cff17552652d4c83997cfc356469cb6652e02e7515fdd94df7569a5854b08a856bd0e01d7fb2a3d852d4b726cc902d762b36db802a39bf18b45110d9f5a4f

PubMed: 25392857
Pub PDF: PDF icon 25392857.pdf

Abstract
OBJECTIVES:
Many paediatric antiretroviral therapy (ART) programmes in Southern Africa rely on CD4⁺ to monitor ART. We assessed the benefit of replacing CD4⁺ by viral load monitoring.

DESIGN: A mathematical modelling study.

METHODS: A simulation model of HIV progression over 5 years in children on ART, parameterized by data from seven South African cohorts. We simulated treatment programmes with 6-monthly CD4⁺ or 6- or 12-monthly viral load monitoring. We compared mortality, second-line ART use, immunological failure and time spent on failing ART. In further analyses, we varied the rate of virological failure, and assumed that the rate is higher with CD4⁺ than with viral load monitoring.

RESULTS: About 7% of children were predicted to die within 5 years, independent of the monitoring strategy. Compared with CD4⁺ monitoring, 12-monthly viral load monitoring reduced the 5-year risk of immunological failure from 1.6 to 1.0% and the mean time spent on failing ART from 6.6 to 3.6 months; 1% of children with CD4⁺ compared with 12% with viral load monitoring switched to second-line ART. Differences became larger when assuming higher rates of virological failure. When assuming higher virological failure rates with CD4⁺ than with viral load monitoring, up to 4.2% of children with CD4⁺ compared with 1.5% with viral load monitoring experienced immunological failure; the mean time spent on failing ART was 27.3 months with CD4⁺ monitoring and 6.0 months with viral load monitoring. Conclusion: Viral load monitoring did not affect 5-year mortality, but reduced time on failing ART, improved immunological response and increased switching to second-line ART.
 

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Citation:

Salazar-Vizcaya L, Keiser O, Karl Technau, Davies MA, Haas AD, Blaser N, Cox V, Eley B, Rabie H, Moultrie H, Giddy J, Wood R, Egger M, Estill J. Viral load versus CD4⁺ monitoring and 5-year outcomes of antiretroviral therapy in HIV-positive children in Southern Africa: a cohort-based modelling study. AIDS. 2014 Oct 23;28(16):2451-60. PubMed PMID: 25392857; PubMed Central PMCID: PMC4231439.