Skip to content
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Outcomes of antiretroviral treatment in programmes with and without routine viral load monitoring in southern Africa
AIDS, Volume 25, No. 14, Year 2011
Notification
URL copied to clipboard!
Description
Objectives: To compare outcomes of antiretroviral therapy (ART) in South Africa, where viral load monitoring is routine, with those in Malawi and Zambia, where monitoring is based on CD4 + cell counts. Methods: We included 18706 adult patients starting ART in South Africa and 80937 patients in Zambia or Malawi. We examined CD4 + responses in models for repeated measures and the probability of switching to second-line regimens, mortality and loss to follow-up in multistate models, measuring time from 6 months. Results: In South Africa, 9.8% [95% confidence interval (CI) 9.1-10.5] had switched at 3 years, 1.3% (95% CI 0.9-1.6) remained on failing first-line regimens, 9.2% (95% CI 8.5-9.8) were lost to follow-up and 4.3% (95% CI 3.9-4.8) had died. In Malawi and Zambia, more patients were on a failing first-line regimen [3.7% (95% CI 3.6-3.9], fewer patients had switched [2.1% (95% CI 2.0-2.3)] and more patients were lost to follow-up [15.3% (95% CI 15.0-15.6)] or had died [6.3% (95% CI 6.0-6.5)]. Median CD4 + cell counts were lower in South Africa at the start of ART (93 vs. 132cells/μl; P<0.001) but higher after 3 years (425 vs. 383cells/μl; P<0.001). The hazard ratio comparing South Africa with Malawi and Zambia after adjusting for age, sex, first-line regimen and CD4 + cell count was 0.58 (0.50-0.66) for death and 0.53 (0.48-0.58) for loss to follow-up. Conclusion: Over 3 years of ART mortality was lower in South Africa than in Malawi or Zambia. The more favourable outcome in South Africa might be explained by viral load monitoring leading to earlier detection of treatment failure, adherence counselling and timelier switching to second-line ART. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Keiser, Olivia
Switzerland, Bern
University of Bern
Chi, Benjamin H.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Gsponer, Thomas
Switzerland, Bern
University of Bern
Boulle, Andrew
United Kingdom
School of Public Health and Family Medicine
Orrell, Catherine J.
South Africa, Cape Town
University of Cape Town
Phiri, Sam John Peter
Malawi, Lilongwe
Kamuzu Central Hospital
Maxwell, Nicola
United Kingdom
School of Public Health and Family Medicine
Maskew, Mhairi
South Africa, Johannesburg
University of the Witwatersrand
Prozesky, Hans (Hw)
South Africa, Tygerberg
Tygerberg Hospital
Fox, Matthew P.
South Africa, Johannesburg
University of the Witwatersrand
United States, Boston
Boston University
Westfall, Andrew O.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Egger, Matthias
Switzerland, Bern
University of Bern
Statistics
Citations: 122
Authors: 12
Affiliations: 9
Identifiers
Doi:
10.1097/QAD.0b013e328349822f
e-ISSN:
14735571
Research Areas
Environmental
Study Design
Cohort Study
Study Locations
Malawi
South Africa
Zambia