Article Text

other Versions

PDF
Original article
Determinants of virological failure after 1 year's antiretroviral therapy in Vietnamese people with HIV: findings from a retrospective cohort of 13 outpatient clinics in six provinces
  1. Dam Anh Tran1,2,
  2. David P Wilson1,
  3. Anthony Shakeshaft2,
  4. Anh Duc Ngo3,
  5. Christopher Doran4,
  6. Lei Zhang1
  1. 1Kirby Institute, The University of New South Wales, Sydney, New South Wales, Australia
  2. 2National Drug Alcohol Research Centre, The University of New South Wales, Sydney, New South Wales, Australia
  3. 3The University of South Australia, Adelaide, South Australia, Australia
  4. 4Hunter Medical Research Centre, The University of Newcastle, Newcastle, Australia
  1. Correspondence to Dam Anh Tran, Lei Zhang Kirby Institute, National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, Australia, NSW 2301; d.tran{at}unsw.edu.au, lzhang{at}kirby.unsw.edu.au

Abstract

Objective To examine access to routine viral load testing and causes of virological failure after 1 year of antiretroviral therapy (ART) among people with HIV. Additionally, to evaluate the positive predictive value (PPV) of immunological criteria to detect treatment failure.

Method A retrospective cohort of 3449 people with HIV who started ART between 1 January 2005 and 31 December 2009 in 13 outpatient clinics in Vietnam was studied. Cox hazard regression modelling was used to calculate crude and adjusted HRs and 95% CIs for associations between patient characteristics and virological failure.

Results Only 63% (2010/3199) of patients had access to routine viral load testing after 1 year of ART. After adjusting for other factors, patients with a baseline CD4 count of 50–100, 101–200 and 201–350 cells/mm3 were 0.48 (95% CI 0.20 to 0.74), 0.63 (95% CI 0.23 to 0.82) and 0.73 times (95% CI 0.14 to 0.95) as likely to have virological failure, respectively, as those with a baseline CD4 count <50 cells/mm3. After adjusting for other factors, patients with good treatment adherence were 0.54 times as likely to have viraemia as those with poor treatment adherence (95% CI 0.28 to 0.81) and patients with immunological failure were 1.43 times as likely to have viraemia (95% CI 1.31 to 1.65) as those without. The PPV of immunological criteria was 60.1% (95% CI 57.1% to 69.3%).

Conclusions Routine viral load tests should be conducted early to detect virological failure and prevent unnecessary changes to second-line treatments. To improve treatment outcomes, timely ART initiation and treatment adherence should be promoted.

  • VIROLOGY HIV
  • ANTERETROVIRAL THERAPY
  • HIV
  • ADHERENCE

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.