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. 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

Awachana Jiamsakul  1 , Azar Kariminia, Keri N Althoff, Carina Cesar, Claudia P Cortes, Mary-Ann Davies, Viet Chau Do, Brian Eley, John Gill, Nagalingeswaran Kumarasamy, Daisy Maria Machado, Richard Moore, Hans Prozesky, Elizabeth Zaniewski, Matthew Law
Affiliations

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

Awachana Jiamsakul et al. J Acquir Immune Defic Syndr. .

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.

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Conflict of interest statement

Conflicts of interest: All authors stated that they have no conflicts of interest.

Figures

Figure 1
Figure 1. Proportion of adults with viral load (VL) suppression using (a) strict intention-to-treat; and (b) modified intention-to-treat methods
Abbreviations: CCASAnet - Caribbean, Central and South America; VL – viral load
Figure 2
Figure 2. Proportion of paediatric patients with viral load (VL) suppression using (a) strict intention-to-treat; and (b) modified intention-to-treat methods
Abbreviations: CCASAnet - Caribbean, Central and South America; VL – viral load.
See this image and copyright information in PMC

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