Measures of site resourcing predict virologic suppression,immunologic response and HIV disease progression following highly active antiretroviral therapy (HAART) in the TREAT Asia HIV Observational Database (TAHOD) |
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| Authors: | R Oyomopito MP Lee P Phanuphak PL Lim R Ditangco J Zhou T Sirisanthana YMA Chen S Pujari N Kumarasamy S Sungkanuparph CKC Lee A Kamarulzaman S Oka FJ Zhang CV Mean T Merati G Tau J Smith PCK Li |
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| Affiliation: | 1. National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia;2. School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia;3. Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China;4. HIV‐NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand;5. Tan Tock Seng Hospital, Singapore;6. Research Institute for Tropical Medicine, Manila, Philippines;7. Research Institute for Health Sciences, Chiang Mai, Thailand;8. AIDS Prevention and Research Centre, National Yang‐Ming University, Taipei, Taiwan;9. Institute of Infectious Diseases, Pune, India;10. YRG Centre for AIDS Research and Education, Chennai, India;11. Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;12. Hospital Sungai Buloh, Kuala Lumpur, Malaysia;13. University of Malaya, Kuala Lumpur, Malaysia;14. International Medical Centre of Japan, Tokyo, Japan;15. Beijing Ditan Hospital, Beijing, China;16. National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia;17. Faculty of Medicine, Udayana University & Sanglah Hospital, Bali, Indonesia;18. Port Moresby General Hospital, Port Moresby, Papua New Guinea;19. The Foundation for AIDS Research, New York, NY, USA |
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| Abstract: | Objectives Surrogate markers of HIV disease progression are HIV RNA in plasma viral load (VL) and CD4 cell count (immune function). Despite improved international access to antiretrovirals, surrogate marker diagnostics are not routinely available in resource‐limited settings. Therefore, the objective was to assess effects of economic and diagnostic resourcing on patient treatment outcomes. Methods Analyses were based on 2333 patients initiating highly active antiretroviral therapy (HAART) from 2000 onwards. Sites were categorized by World Bank country income criteria (high/low) and annual frequency of VL (≥3, 1–2 or <1) or CD4 (≥3 or <3) testing. Endpoints were time to AIDS/death and change in CD4 cell count and VL suppression (<400 HIV‐1 RNA copies/mL) at 12 months. Demographics, Centers for Disease Control and Prevention (CDC) classification, baseline VL/CD4 cell counts, hepatitis B/C coinfections and HAART regimen were covariates. Time to AIDS/death was analysed by proportional hazards models. CD4 and VL endpoints were analysed using linear and logistic regression, respectively. Results Increased disease progression was associated with site‐reported VL testing less than once per year [hazard ratio (HR)=1.4; P=0.032], severely symptomatic HIV infection (HR=1.4; P=0.003) and hepatitis C virus coinfection (HR=1.8; P=0.011). A total of 1120 patients (48.2%) had change in CD4 cell count data. Smaller increases were associated with older age (P<0.001) and ‘Other’ HIV source exposures, including injecting drug use and blood products (P=0.043). A total of 785 patients (33.7%) contributed to the VL suppression analyses. Patients from sites with VL testing less than once per year [odds ratio (OR)=0.30; P<0.001] and reporting ‘Other’ HIV exposures experienced reduced suppression (OR=0.28; P<0.001). Conclusion Low measures of site resourcing were associated with less favourable patient outcomes, including a 35% increase in disease progression in patients from sites with VL testing less than once per year. |
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| Keywords: | antiretroviral therapy Asia CD4 counts diagnostic monitoring viral load |
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