. 2021 Dec;8(12):e766-e775.

doi: 10.1016/S2352-3018(21)00265-4.

Global estimates of viral suppression in children and adolescents and adults on antiretroviral therapy adjusted for missing viral load measurements: a multiregional, retrospective cohort study in 31 countries

Win Min Han¹, Matthew G Law², Matthias Egger³, Kara Wools-Kaloustian⁴, Richard Moore⁵, Catherine McGowan⁶, Nagalingesawaran Kumarasamy⁷, Sophie Desmonde⁸, Andrew Edmonds⁹, Mary-Ann Davies¹⁰, Constantin Yiannoutsos¹¹, Keri N Althoff¹², Claudia P Cortes¹³, Thahira Jamal Mohamed¹⁴, Antoine Jaquet¹⁵, Kathryn Anastos¹⁶, Jonathan Euvrard¹⁰, Barbara Castelnuovo¹⁷, Kate Salters¹⁸, Lara Esteves Coelho¹⁹, Didier K Ekouevi²⁰, Brian Eley²¹, Lameck Diero²², Elizabeth Zaniewski²³, Nathan Ford²⁴, Annette H Sohn²⁵, Azar Kariminia²; IeDEA collaboration

Affiliations

¹ The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand. Electronic address: wmhan@kirby.unsw.edu.au.
² The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
³ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
⁴ Department of Medicine, Indiana University, Indianapolis, IN, USA.
⁵ School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁶ Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.
⁷ Chennai Antiviral Research and Treatment Clinical Research Site, The Voluntary Health Services, Chennai, India.
⁸ INSERM U1027, Toulouse III University, Toulouse, France.
⁹ Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁰ Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
¹¹ RM Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.
¹² Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
¹³ Fundación Arriaran-Facultad de Medicina Universidad de Chile, Santiago, Chile.
¹⁴ Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
¹⁵ University of Bordeaux, Inserm, French National Research Institute for Sustainable Development, UMR 1219, Bordeaux, France.
¹⁶ Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
¹⁷ Infectious Diseases Institute, Makerere University, Kampala, Uganda.
¹⁸ British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada.
¹⁹ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
²⁰ Program PAC-CI, Abidjan, Côte d'Ivoire; Bordeaux Population Health (UMR1219), Bordeaux, France.
²¹ Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
²² Department of Medicine, Moi University School of Medicine and Moi Teaching and Referral Hospital, Eldoret, Kenya.
²³ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
²⁴ Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; HIV/AIDS Department and Global Hepatitis Program, WHO, Geneva, Switzerland.
²⁵ TREAT Asia/amfAR, The Foundation for AIDS Research, Bangkok, Thailand.

PMID: 34856180
PMCID: PMC8782625
DOI: 10.1016/S2352-3018(21)00265-4

Global estimates of viral suppression in children and adolescents and adults on antiretroviral therapy adjusted for missing viral load measurements: a multiregional, retrospective cohort study in 31 countries

Win Min Han et al. Lancet HIV. 2021 Dec.

. 2021 Dec;8(12):e766-e775.

doi: 10.1016/S2352-3018(21)00265-4.

Authors

Affiliations

¹ The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand. Electronic address: wmhan@kirby.unsw.edu.au.
² The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
³ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
⁴ Department of Medicine, Indiana University, Indianapolis, IN, USA.
⁵ School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁶ Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.
⁷ Chennai Antiviral Research and Treatment Clinical Research Site, The Voluntary Health Services, Chennai, India.
⁸ INSERM U1027, Toulouse III University, Toulouse, France.
⁹ Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁰ Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
¹¹ RM Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.
¹² Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
¹³ Fundación Arriaran-Facultad de Medicina Universidad de Chile, Santiago, Chile.
¹⁴ Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
¹⁵ University of Bordeaux, Inserm, French National Research Institute for Sustainable Development, UMR 1219, Bordeaux, France.
¹⁶ Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
¹⁷ Infectious Diseases Institute, Makerere University, Kampala, Uganda.
¹⁸ British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada.
¹⁹ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
²⁰ Program PAC-CI, Abidjan, Côte d'Ivoire; Bordeaux Population Health (UMR1219), Bordeaux, France.
²¹ Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
²² Department of Medicine, Moi University School of Medicine and Moi Teaching and Referral Hospital, Eldoret, Kenya.
²³ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
²⁴ Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; HIV/AIDS Department and Global Hepatitis Program, WHO, Geneva, Switzerland.
²⁵ TREAT Asia/amfAR, The Foundation for AIDS Research, Bangkok, Thailand.

PMID: 34856180
PMCID: PMC8782625
DOI: 10.1016/S2352-3018(21)00265-4

Abstract

Background: As countries move towards the UNAIDS's 95-95-95 targets and with strong evidence that undetectable equals untransmittable, it is increasingly important to assess whether those with HIV who are receiving antiretroviral therapy (ART) achieve viral suppression. We estimated the proportions of children and adolescents and adults with viral suppression at 1, 2, and 3 years after initiating ART.

Methods: In this retrospective cohort study, seven regional cohorts from the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium contributed data from individuals initiating ART between Jan 1, 2010, and Dec 31, 2019, at 148 sites in 31 countries with annual viral load monitoring. Only people with HIV who started ART after the time a site started routine viral load monitoring were included. Data up to March 31, 2020, were analysed. We estimated the proportions of children and adolescents (aged <18 years at ART initiation) and adults (aged ≥18 years at ART initiation) with viral suppression (viral load <1000 copies per mL) at 1, 2, and 3 years after ART initiation using an intention-to-treat approach and an adjusted approach that accounted for missing viral load measurements.

Findings: 21 594 children and adolescents (11 812 [55%] female, 9782 [45%] male) from 106 sites in 22 countries and 255 662 adults (163 831 [64%] female, 91 831 [36%] male) from 143 sites in 30 countries were included. Using the intention-to-treat approach, the proportion of children and adolescents with viral suppression was 7303 (36%) of 20 478 at 1 year, 5709 (30%) of 19 135 at 2 years, and 4287 (24%) of 17 589 at 3 years after ART initiation; the proportion of adults with viral suppression was 106 541 (44%) of 240 600 at 1 year, 79 141 (36%) of 220 925 at 2 years, and 57 970 (29%) of 201 124 at 3 years after ART initiation. After adjusting for missing viral load measurements among those who transferred, were lost to follow-up, or who were in follow-up without viral load testing, the proportion of children and adolescents with viral suppression was 12 048 (64% [plausible range 43-81]) of 18 835 at 1 year, 10 796 (62% [41-77]) of 17 553 at 2 years, and 9177 (59% [38-91]) of 15 667 at 3 years after ART initiation; the proportion of adults with viral suppression was 176 964 (79% [53-80]) of 225 418 at 1 year, 145 552 (72% [48-79]) of 201 238 at 2 years, and 115 260 (65% [43-69]) of 178 458 at 3 years after ART initiation.

Interpretation: Although adults with HIV are approaching the global target of 95% viral suppression, progress among children and adolescents is much slower. Substantial efforts are still needed to reach the viral suppression target for children and adolescents.

Funding: US National Institutes of Health.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests AHS reports grant support to her institution for activities unrelated to this work. MGL reports unrestricted grants from Gilead Sciences, Janssen–Cilag, and ViiV Healthcare. CPC reports grant support from National Institutes of Health (NIH; U01AI069923) and consultation fees and honoraria from GSK–ViiV, and Merck. KNA reports grant support from NIH, with funding payments made to her institution; and consultation fees from the All of Us Research Program (NIH) and Trio Health. All other authors report no competing interests.

Figures

**Figure 1.**
HIV viral suppression and treatment outcomes for children/adolescents and adults with HIV in the IeDEA global consortium by region at years 1, 2, and 3 following ART initiation (ITT analysis). The proportions presented in this Figure and the estimated weighted averages are provided in table S1 (appendix pp 3–4).

**Figure 2.**
HIV viral suppression proportions using ITT, children/adolescents and adults with viral load measurements and adjusted analyses in the IeDEA global consortium at years 1, 2, and 3 following ART initiation

See this image and copyright information in PMC

Comment in

Moving towards the global HIV 95% viral suppression target.
Bessong PO, Mavhandu-Ramarumo LG. Bessong PO, et al. Lancet HIV. 2021 Dec;8(12):e731-e732. doi: 10.1016/S2352-3018(21)00273-3. Lancet HIV. 2021. PMID: 34856177 No abstract available.

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Global estimates of viral suppression in children and adolescents and adults on antiretroviral therapy adjusted for missing viral load measurements: a multiregional, retrospective cohort study in 31 countries

Affiliations

Global estimates of viral suppression in children and adolescents and adults on antiretroviral therapy adjusted for missing viral load measurements: a multiregional, retrospective cohort study in 31 countries

Authors

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Abstract

Conflict of interest statement

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