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Meta-Analysis
. 2015 Nov 1;61(9):1453-61.
doi: 10.1093/cid/civ556. Epub 2015 Jul 8.

Long-term Virological Outcomes of First-Line Antiretroviral Therapy for HIV-1 in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis

T Sonia Boender  1 , Kim C E Sigaloff  2 , James H McMahon  3 , Sasisopin Kiertiburanakul  4 , Michael R Jordan  5 , Jhoney Barcarolo  6 , Nathan Ford  6 , Tobias F Rinke de Wit  1 , Silvia Bertagnolio  6
Affiliations
Meta-Analysis

Long-term Virological Outcomes of First-Line Antiretroviral Therapy for HIV-1 in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis

T Sonia Boender et al. Clin Infect Dis. .

Abstract

Background: More than 11.7 million people are currently receiving antiretroviral therapy (ART) in low- and middle-income countries (LMICs), and focused efforts are needed to ensure high levels of adherence and to minimize treatment failure. Recently, international targets have emphasized the importance of long-term virological suppression as a key measure of program performance.

Methods: We systematically reviewed publications and conference abstracts published between January 2006 and May 2013 that reported virological outcomes among human immunodeficiency virus type 1 (HIV-1)-infected adults receiving first-line ART for up to 5 years in LMICs. Summary estimates of virological suppression after 6, 12, 24, 36, 48, and 60 months of ART were analyzed using random-effects meta-analysis. Intention-to-treat (ITT) analysis assumed all participants who were lost to follow-up, died, or stopped ART as having virological failure.

Results: Summary estimates of virological suppression remained >80% for up to 60 months of ART for all 184 included cohorts. ITT analysis yielded 74.7% (95% confidence interval [CI], 72.2-77.2) suppression after 6 months and 61.8% (95% CI, 44.0-79.7) suppression after 48 months on ART. Switches to second-line ART were reported scarcely.

Conclusions: Among individuals retained on ART, virological suppression rates during the first 5 years of ART were high (>80%) and stable. Suppression rates in ITT analysis declined during 4 years.

Keywords: HIV-1; antiretroviral therapy; low- and middle-income countries; virological monitoring.

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Figures

Figure 1.
Figure 1.
Flow chart of study selection. An asterisk (*) indicates studies without original or virological data, studies with a design not meeting inclusion criteria or without specific data on duration of antiretroviral treatment (ART), studies outside low- and middle-income countries, and studies with only pediatric participants. Abbreviations: CENTRAL, Cochrane Central Register of Controlled Trials; CROI, Conference on Retroviruses and Opportunistic Infections; HIV, human immunodeficiency virus; IAS, International AIDS Society; LMIC, low- and middle-income countries; PASER, Pan-African Studies to Evaluate Resistance; TREAT Asia, Therapeutics Research, Education, and AIDS Training in Asia.
Figure 2.
Figure 2.
World map indicating 35 countries reporting data included.
Figure 3.
Figure 3.
Summary estimates of virological suppression outcomes. Note: All summary estimates are informed by a forest plot (see Supplementary Figures). Full tables of the subgroup analysis are provided in Supplementary Tables.
Figure 4.
Figure 4.
Switches to second-line therapy.
See this image and copyright information in PMC

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