Frequency of HIV-1 Viral Load Monitoring of Patients Initially Successfully Treated with Combination Antiretroviral Therapy

Abstract

BackgroundAlthough considered an essential tool for monitoring the effect of combination antiretroviral treatment (CART), HIV-1 RNA (viral load, VL) testing is greatly influenced by cost and availability of resources.ObjectivesTo examine whether HIV infected patients who were initially successfully treated with CART have less frequent monitoring of VL over time and whether CART failure and other HIV-disease and sociodemographic characteristics are associated with less frequent VL testing.MethodsThe study included patients who started CART in the period 1999–2004, were older than 18 years, CART naive, had two consecutive viral load measurements of <400 copies/ml after 5 months of treatment and had continuous CART during the first 15 months. The time between two consecutive visits (days) was the outcome and associated factors were assessed using linear mixed models.ResultsWe analyzed a total of 128 patients with 1683 visits through December 2009. CART failure was observed in 31 (24%) patients. When adjusted for the follow-up time, the mean interval between two consecutive VL tests taken in patients before CART failure (155.2 days) was almost identical to the interval taken in patients who did not fail CART (155.3 days). On multivariable analysis, we found that the adjusted estimated time between visits was 150.9 days before 2003 and 177.6 in 2008/2009. A longer time between visits was observed in seafarers compared to non-seafarers; the mean difference was 30.7 days (95% CI, 14.0 to 47.4; p<0.001); and in individuals who lived more than 160 kilometers from the HIV treatment center (mean difference, 16 days, p = 0.010).ConclusionsLess frequent monitoring of VL became common in recent years and was not associated with failure. We identified seafarers as a population with special needs for CART monitoring and delivery.

The Prevalence of Transmitted Drug Resistance in Newly Diagnosed HIV-Infected Individuals in Croatia: The Role of Transmission Clusters of Men Who Have Sex with Men Carrying the T215S Surveillance Drug Resistance Mutation

“…For example, in 2009, out of 26 antiretroviral drugs registered in the EU, only 14 were available in Croatia. 5 The majority of HIV-1 infections in Croatia are associated with subtype B. Molecular analysis of HIV subtypes in 145 Croatian patients (2001)(2002)(2003) from different risk groups showed that 26% of infections were due to non-B subtypes (predominantly CRF02_AG, subtype C, subtype A, and CRF10_CD). 6 Non-B subtype infections were found only in Croatian patients with heterosexual exposure (predominantly seafarers and their steady female partners) whereas HIV epidemics in MSM were due to subtype B infections only.…”

The Association of Clinical Follow-Up Intervals in HIV-Infected Persons with Viral Suppression on Subsequent Viral Suppression

“…Persons in our study with a CD4 cell count < 200 cells/mm 3 were more likely to have virologic failure at 12 months. CD4 cell count at entry into our cohort may be at least a partial surrogate for duration of viral suppression prior to entering the cohort (a variable that we could not measure).…”

“…Similar numbers of participants had private health insurance, Medicare, Medicaid, and no insurance. The median (IQR) CD4 cell count at the index visit was 497 (345, 692) cells/mm 3 . Sixty-six percent of participants had a followup appointment scheduled at 3 months, 26% at 4 months, and 8% at 6 months.…”

“…Among the other variables we studied, virologic failure was statistically significantly predicted by insurance status (3.0%, 6.5%, 7.3%, and 8.5% for persons with private health insurance, Medicaid, Medicare, and no health insurance, respectively [p = 0.01]), CD4 cell count at index visit (12.0%, 9.2%, and 5.3% for persons with CD4 count < 200 cells/mm 3 , between 200 and 350 cells/mm 3 , and > 350 cells/mm 3 , respectively [p < 0.01]), and disposition of the next scheduled follow-up appointment (5.1%, 7.9%, and 11.6% for persons who kept, cancelled, and missed the appointment, respectively [p < 0.01]).…”

HIV Viral Load Monitoring Frequency and Risk of Treatment Failure among Immunologically Stable HIV-Infected Patients Prescribed Combination Antiretroviral Therapy

“…These data are similar to data reported by Romih and colleagues in Croatia involving a smaller cohort of 128 patients initiating cART, in which there was no difference in VL monitoring frequency between patients who did or did not experience VF. 7 Another small randomized prospective study found no difference in VF rates among 165 individuals with CD4 ≥250 cells/mm 3 and undetectable VLs for more than 12 months who were randomized to receive VL monitoring either every 4 or every 6 months. 8 …”