HIV viral load suppression in adults and children receiving antiretroviral therapy - results from the IeDEA collaboration.

Sat, 08 Jul 2017 00:00:00 GMT-05:00 - Jiamsakul, Awachana; Kariminia, Azar; Althoff, Keri N; Cesar, Carina; Cortes, Claudia P; Davies, Mary-Ann; Do, Viet Chau; Eley, Brian; Gill, John; Kumarasamy, Nagalingeswaran; Machado, Daisy Maria; Moore, Richard; Prozesky, Hans; Zaniewski, Elizabeth; Law, Matthew
Εισαγωγή: Having 90% of patients on antiretroviral therapy (ART) and achieving an undetectable viral load (VL) is one 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 three years after ART initiation.
Μέθοδοι: Patients from the IeDEA cohorts who initiated ART between 2010 and 2014 were included. Proportions with VL suppression (<1000 copies/mL) were estimated using: (i) strict intention-to-treat (ITT) - loss to follow-up (LTFU) and dead patients counted as having detectable VL; and (ii) modified ITT - LTFU and dead patients were excluded. Logistic regression was used to identify predictors of viral suppression at one year after ART initiation using modified ITT.
Αποτελέσματα: A total of 35561 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 three 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 VL suppression. In children, older age and higher CD4 percentage pre-ART showed significant associations with VL suppression.
Συμπεράσματα: 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 minimise LTFU and maximise patient retention in HIV-infected patients of all age groups. - (C) 2017

Gender differences in outcomes of antiretroviral treatment among HIV-infected patients in China: a retrospective cohort study, 2010-2015.

Sat, 08 Jul 2017 00:00:00 GMT-05:00 - Chen, Meiling; Dou, Zhihui; Wang, Liming; Wu, Yasong; Zhao, Decai; Gan, Xiumin; Ran, Hu; Ma, Ye; Fujie, Zhang Backgroud: Women now account for about half of all people living with HIV worldwide, but researchers lack clear information and large population-based study about gender differences in treatment outcomes.
Μέθοδοι: A nationwide retrospective observational cohort study with data from the China National Free Antiretroviral Treatment Program was carried out. Antiretroviral-naive patients older than 18 years initiating standard antiretroviral therapy between January 1, 2010 and December 31, 2011 were included and followed up to Dec 31, 2015. We used modified Poisson regression models to estimate the impact of gender on virological suppression and retention in treatment, and Kaplan-Meier analysis and Cox proportional hazard models to evaluate gender difference in mortality.
Αποτελέσματα: 68646 patients (46083 (67.1%) men and 22563 (32.9%) women) with HIV met eligibility criteria. Women were significantly more likely to achieve virological suppression than men both at 12 months (adjusted relative risk [aRR] 1.02, 95%CI 1.01-1.03, p<0.001) and 48 months (aRR 1.01, 95%CI 1.00-1.02,p=0.005) after initiating antiretroviral treatment. Women were also more likely to remain in treatment at 12 months (aRR 1.02, 95%CI 1.01-1.02,p<0.001) and 48 months (aRR 1.04, 95%CI 1.03-1.05,p<0.001), although the difference became insignificant in alive patients. All-cause mortality was lower in women than in men (2.34 vs. 4.03 deaths/100PY, adjusted hazard ratio 0.72, 95%CI 0.67-0.77, p<0.001).
Συμπεράσματα: In China, women are more likely to achieve virological suppression, remain in treatment and have a significantly lower risk of death than men. Future studies could take both biological and socio-behavioral factors into analysis to clarify the influence factors. - (C) 2017