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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
The virological durability of first-line ART among HIV-positive adult patients in resource limited settings without virological monitoring: A retrospective analysis of DART trial data
BMC Infectious Diseases, Volume 17, No. 1, Article 160, Year 2017
Notification
URL copied to clipboard!
Description
Background: Few low-income countries have virological monitoring widely available. We estimated the virological durability of first-line antiretroviral therapy (ART) after five years of follow-up among adult Ugandan and Zimbabwean patients in the DART study, in which virological assays were conducted retrospectively. Methods: DART compared clinically driven monitoring with/without routine CD4 measurement. Annual plasma viral load was measured on 1,762 patients. Analytical weights were calculated based on the inverse probability of sampling. Time to virological failure, defined as the first viral load measurement ≥200 copies/mL after 48 weeks of ART, was analysed using Kaplan-Meier plots and Cox regression models. Results: Overall, 65% of DART trial patients were female. Patients initiated first-line ART at a median (interquartile range; IQR) age of 37 (32-42) and with a median CD4 cell count of 86 (32-140). After 240 weeks of ART, patients initiating dual-class nucleoside reverse-transcriptase inhibitor (NRTI) -non-nucleoside reverse-transcriptase (NNRTI) regimens containing nevirapine + zidovudine + lamivudine had a lower incidence of virological failure than patients on triple-NRTI regimens containing tenofovir + zidovudine + lamivudine (21% vs 40%; hazard ratio (HR) =0.48, 95% CI:0.38-0.62; p < 0.0001). In multivariate analyses, female patients (HR = 0.79, 95% CI: 0.65-0.95; p = 0.02), older patients (HR = 0.73 per 10 years, 95% CI: 0.64-0.84; p < 0.0001) and patients with a higher pre-ART CD4 cell count (HR = 0.64 per 100 cells/mm3, 95% CI: 0.54-0.75; p < 0.0001) had a lower incidence of virological failure after adjusting for adherence to ART. No difference in failure rate between the two randomised monitoring strategies was observed (p= 0.25). Conclusions: The long-term durability of virological suppression on dual-class NRTI-NNRTI first-line ART without virological monitoring is remarkable and is enabled by high-quality clinical management and a consistent drug supply. To achieve higher rates of virological suppression viral-load-informed differentiated care may be required. Trial Registration: Prospectively registered on 18/10/2000 as ISRCTN13968779. © 2017 The Author(s).
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC5319022/bin/12879_2017_2266_MOESM1_ESM.docx
Authors & Co-Authors
Dolling, David I.
United Kingdom, London
University College London
Goodall, Ruth L.
United Kingdom, London
University College London
Chirara, Michael M.
Zimbabwe, Harare
University of Zimbabwe
Hakim, James Gita
Zimbabwe, Harare
University of Zimbabwe
Nkurunziza, Peter M.
Uganda, Kampala
Joint Clinical Research Center Uganda
Munderi, Paula
Uganda, Kampala
Joint Clinical Research Center Uganda
Eram, David
United Kingdom, London
Medical Research Council
Tumukunde, Dinah
United Kingdom, London
Medical Research Council
Spyer, Moira J.
United Kingdom, London
University College London
Gilks, Charles F.
Australia, Brisbane
The University of Queensland
United Kingdom, London
Imperial College London
Kaleebu, Pontiano
Uganda, Kampala
Joint Clinical Research Center Uganda
Dunn, David T.
United Kingdom, London
University College London
Morris, Lynn G.
South Africa, Durban
Africa Health Research Institute
P Kaleebu,
Unknown Affiliation
Pillay, Deenan G.
Unknown Affiliation
Awio, P.
Unknown Affiliation
Dunn, David D.
Unknown Affiliation
Gibb, D. M.
Unknown Affiliation
Kapaata, Anne A.
Unknown Affiliation
Katuramur, M.
Unknown Affiliation
Lyagoba, F.
United Kingdom, London
Medical Research Council
Magambo, Brian
Unknown Affiliation
Mataruka, K.
Unknown Affiliation
Mugarura, Lincoln
Unknown Affiliation
Musunga, T.
Unknown Affiliation
Nabankkema, M.
Unknown Affiliation
Nkalubo, J.
Unknown Affiliation
Nkurunziza, Peter
Unknown Affiliation
Parry, Chris M.
Unknown Affiliation
Robertson, V.
Unknown Affiliation
Spyer, Moira J.
Unknown Affiliation
Mulima, Disan
Unknown Affiliation
Williams, David Eram
Unknown Affiliation
Nankya, Immaculate L.
Unknown Affiliation
Nassimbwa, Sureyah
Unknown Affiliation
Ndashimye, Emmanuel
Unknown Affiliation
Nabulime, Eva
Unknown Affiliation
Phiri, Mary
Unknown Affiliation
Mutasa, Kuda E.
Unknown Affiliation
Mukasa, Simon
Unknown Affiliation
Grosskurth, Heiner
United Kingdom, London
Medical Research Council
Munderi, Paula
United Kingdom, London
Medical Research Council
Kabuye, Geoffrey
United Kingdom, London
Medical Research Council
Nsibambi, D.
United Kingdom, London
Medical Research Council
Kasirye, Ronnie P.
United Kingdom, London
Medical Research Council
Zalwango, Eva
United Kingdom, London
Medical Research Council
Nakazibwe, M.
United Kingdom, London
Medical Research Council
Kikaire, Bernard
United Kingdom, London
Medical Research Council
Nassuna, Gladys
United Kingdom, London
Medical Research Council
Massa, Rosemary
United Kingdom, London
Medical Research Council
Fadhiru, K.
United Kingdom, London
Medical Research Council
Namyalo, M.
United Kingdom, London
Medical Research Council
Zalwango, Aisha
United Kingdom, London
Medical Research Council
Generous, Lillian
United Kingdom, London
Medical Research Council
Khauka, P.
United Kingdom, London
Medical Research Council
Rutikarayo, N.
United Kingdom, London
Medical Research Council
Nakahima, William
United Kingdom, London
Medical Research Council
Mugisha, Annet
United Kingdom, London
Medical Research Council
Todd, Jim E.
United Kingdom, London
Medical Research Council
Levin, Jonathan B.
United Kingdom, London
Medical Research Council
Muyingo, Sylvia Kiwuwa
United Kingdom, London
Medical Research Council
Ruberantwari, Anthony
United Kingdom, London
Medical Research Council
Kaleebu, Pontiano
United Kingdom, London
Medical Research Council
Yirrell, David L.
United Kingdom, London
Medical Research Council
Ndembi, Nicaise N.
United Kingdom, London
Medical Research Council
Hughes, Peter
United Kingdom, London
Medical Research Council
Aber, M.
United Kingdom, London
Medical Research Council
Medina Lara, A.
United Kingdom, London
Medical Research Council
Foster, Stephanie L.
United Kingdom, London
Medical Research Council
Amurwon, Jovita
United Kingdom, London
Medical Research Council
Nyanzi-Wakholi, Barbara
United Kingdom, London
Medical Research Council
Mugyenyi, Peter N.
Uganda, Kampala
Joint Clinical Research Center Uganda
Kityo, Cissy Mutuluuza
Uganda, Kampala
Joint Clinical Research Center Uganda
Ssali, Francis N.
Uganda, Kampala
Joint Clinical Research Center Uganda
Tumukunde, Dinah
Uganda, Kampala
Joint Clinical Research Center Uganda
Otim, T.
Uganda, Kampala
Joint Clinical Research Center Uganda
Kabanda, J.
Uganda, Kampala
Joint Clinical Research Center Uganda
Musana, Hellen Wambongo
Uganda, Kampala
Joint Clinical Research Center Uganda
Akao, Juliette N.
Uganda, Kampala
Joint Clinical Research Center Uganda
Kyomugisha, Hope
Uganda, Kampala
Joint Clinical Research Center Uganda
Byamukama, Adolf
Uganda, Kampala
Joint Clinical Research Center Uganda
Sabiiti, Jesca Nsungwa
Uganda, Kampala
Joint Clinical Research Center Uganda
Komugyena, J.
Uganda, Kampala
Joint Clinical Research Center Uganda
Wavamunno, Priscilla
Uganda, Kampala
Joint Clinical Research Center Uganda
Mukiibi, S.
Uganda, Kampala
Joint Clinical Research Center Uganda
Drasiku, Amos
Uganda, Kampala
Joint Clinical Research Center Uganda
Byaruhanga, Rose
Uganda, Kampala
Joint Clinical Research Center Uganda
Labeja, O.
Uganda, Kampala
Joint Clinical Research Center Uganda
Katundu, Pauline
Uganda, Kampala
Joint Clinical Research Center Uganda
Tugume, Sitefano Buguruka
Uganda, Kampala
Joint Clinical Research Center Uganda
Awio, Peter
Uganda, Kampala
Joint Clinical Research Center Uganda
Namazzi, A.
Uganda, Kampala
Joint Clinical Research Center Uganda
Bakeinyaga, G. T.
Uganda, Kampala
Joint Clinical Research Center Uganda
Katabira, H.
Uganda, Kampala
Joint Clinical Research Center Uganda
Abaine, D.
Uganda, Kampala
Joint Clinical Research Center Uganda
Tukamushaba, J.
Uganda, Kampala
Joint Clinical Research Center Uganda
Anywar, W.
Uganda, Kampala
Joint Clinical Research Center Uganda
Ojiambo, W.
Uganda, Kampala
Joint Clinical Research Center Uganda
Angweng, E.
Uganda, Kampala
Joint Clinical Research Center Uganda
Murungi, S.
Uganda, Kampala
Joint Clinical Research Center Uganda
Haguma, W.
Uganda, Kampala
Joint Clinical Research Center Uganda
Atwiine, Simon Peter
Uganda, Kampala
Joint Clinical Research Center Uganda
Kigozi, Jesse
Uganda, Kampala
Joint Clinical Research Center Uganda
Latif, Ahamed S.
Zimbabwe, Harare
University of Zimbabwe
Robertson, Valerie J.
Zimbabwe, Harare
University of Zimbabwe
Reid, Andrew
Zimbabwe, Harare
University of Zimbabwe
Chidziva, Ennie
Zimbabwe, Harare
University of Zimbabwe
Bulaya-Tembo, Ruth
Zimbabwe, Harare
University of Zimbabwe
Musoro, Godfrey
Zimbabwe, Harare
University of Zimbabwe
Taziwa, Fabian
Zimbabwe, Harare
University of Zimbabwe
Chimbetete, Cleophas
Zimbabwe, Harare
University of Zimbabwe
Chakonza, L.
Zimbabwe, Harare
University of Zimbabwe
Mawora, A.
Zimbabwe, Harare
University of Zimbabwe
Muvirimi, C.
Zimbabwe, Harare
University of Zimbabwe
Tinago, Gloria C.
Zimbabwe, Harare
University of Zimbabwe
Svovanapasis, P.
Zimbabwe, Harare
University of Zimbabwe
Simango, M.
Zimbabwe, Harare
University of Zimbabwe
Chirema, O.
Zimbabwe, Harare
University of Zimbabwe
Machingura, J.
Zimbabwe, Harare
University of Zimbabwe
Mutsai, Shirley
Zimbabwe, Harare
University of Zimbabwe
Phiri, Misheck Nkalo
Zimbabwe, Harare
University of Zimbabwe
Bafana, Themelihle
Zimbabwe, Harare
University of Zimbabwe
Muchabaiwa, Lazarus
Zimbabwe, Harare
University of Zimbabwe
Muzambi, Margaret
Zimbabwe, Harare
University of Zimbabwe
Katabira, Elly Tebasoboke
Uganda, Kampala
Makerere University
Ronald, Allan R.
Uganda, Kampala
Makerere University
Kambungu, A.
Uganda, Kampala
Makerere University
Lutwama, Fred
Uganda, Kampala
Makerere University
Nabankema, Evelyn
Uganda, Kampala
Makerere University
Nalumenya, Ruth
Uganda, Kampala
Makerere University
Namuli, Teopista
Uganda, Kampala
Makerere University
Namata, Ibrahim
Uganda, Kampala
Makerere University
Lubwama, E.
Uganda, Kampala
Makerere University
Buluma, E.
Uganda, Kampala
Makerere University
Ojiambo, Henry
Uganda, Kampala
Makerere University
Wanyama, Jane Namukasa
Uganda, Kampala
Makerere University
Nabongo, Patrick
Uganda, Kampala
Makerere University
Ochai, Robert
Uganda, Entebbe
The Aids Support Organisation Taso
Boocock, K.
United Kingdom, London
Imperial College London
Puddephatt, C.
United Kingdom, London
Imperial College London
Winogron, D.
United Kingdom, London
Imperial College London
Darbyshire, J. H.
United Kingdom, London
University College London
Gibb, Diana M.
United Kingdom, London
University College London
Burke, Andrew
United Kingdom, London
University College London
Bray, Dorothy H.
United Kingdom, London
University College London
Babiker, Abdel G.A.G.
United Kingdom, London
University College London
Walker, Anne Sarah
United Kingdom, London
University College London
Wilkes, Helen C.
United Kingdom, London
University College London
Rauchenberger, Mary
United Kingdom, London
University College London
Sheehan, Stephen
United Kingdom, London
University College London
Peto, Leon
United Kingdom, London
University College London
Taylor, Kay
United Kingdom, London
University College London
Spyer, Moira J.
United Kingdom, London
University College London
Ferrier, Alexander
United Kingdom, London
University College London
Naidoo, Bethany
United Kingdom, London
University College London
Dunn, David T.
United Kingdom, London
University College London
Weller, Ian V.D.
Unknown Affiliation
Babiker, A. G.
Unknown Affiliation
Bahendeka, Silver Karaireho
Unknown Affiliation
Bassett, M.
Unknown Affiliation
Chogo Wapakhabulo, A.
Unknown Affiliation
Darbyshire, Janet H.
Unknown Affiliation
Gazzard, Brian G.
Unknown Affiliation
Grosskurth, Heiner
Unknown Affiliation
Hakim, J.
Unknown Affiliation
Mugurungi, Owen M.
Unknown Affiliation
Mugyenyi, P.
Unknown Affiliation
Loeliger, Edde
Unknown Affiliation
Naidoo, Poobalan
Unknown Affiliation
Rahim, Sibtain
Unknown Affiliation
Rooney, James F.
Unknown Affiliation
Smith, Marshagne
Unknown Affiliation
Snowden, Wendy B.
Unknown Affiliation
Steens, Jean Marc
Unknown Affiliation
Ait-Khaled, Mounir
Unknown Affiliation
Breckenridge, Alasdair M.
Unknown Affiliation
McLaren, A.
Unknown Affiliation
Hill, Catherine Mary
Unknown Affiliation
Matenga, Jonathan Arthur
Unknown Affiliation
Pozniak, Anton Louis
Unknown Affiliation
Serwadda, David Musoke
Unknown Affiliation
Peto, Timothy E.A.
Unknown Affiliation
Palfreeman, Adrian J.
Unknown Affiliation
Borok, Margaret Ziona
Unknown Affiliation
Katabira, E.
Unknown Affiliation
Statistics
Citations: 5
Authors: 185
Affiliations: 9
Identifiers
Doi:
10.1186/s12879-017-2266-3
ISSN:
14712334
Research Areas
Environmental
Infectious Diseases
Study Design
Cohort Study
Participants Gender
Female