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

Dolling, David I., Goodall, Ruth L., Chirara, Michael, Hakim, James , Nkurunziza, Peter, Munderi, Paula, Eram, David, Tumukunde, Dinah, Spyer, Moira J., Gilks, Charles F., Kaleebu, Pontiano, Dunn, David T., Pillay, Deenan, Kaleebu, P. , Pillay, D., Awio, P., Dunn, D., Gibb, D. M., Gilks, C., Kapaata, A., Katuramur, M., Lyagoba, F., Magambo, B., Mataruka, K., Mugarura, L., Musunga, T., Nabankkema, M., Nkalubo, J., Nkurunziza, P., Parry, C., Robertson, V., Spyer, M., Mulima, D., Williams, D. E., Nankya, I., Nassimbwa, S., Ndashimye, E., Nabulime, E., Phiri, M., Mutasa, K., Mukasa, S., Grosskurth, H., Munderi, P., Kabuye, G., Nsibambi, D., Kasirye, R., Zalwango, E., Nakazibwe, M., Kikaire, B., Nassuna, G., Massa, R., Fadhiru, K., Namyalo, M., Zalwango, A., Generous, L., Khauka, P., Rutikarayo, N., Nakahima, W., Mugisha, A., Todd, J., Levin, J., Muyingo, S., Ruberantwari, A., Kaleebu, P., Yirrell, D., Ndembi, N., Lyagoba, F., Hughes, P., Aber, M., Medina Lara, A., Foster, S., Amurwon, J., Nyanzi Wakholi, B., Mugyenyi, P., Kityo, C., Ssali, F., Tumukunde, D., Otim, T., Kabanda, J., Musana, H., Akao, J., Kyomugisha, H., Byamukama, A., Sabiiti, J., Komugyena, J., Wavamunno, P., Mukiibi, S., Drasiku, A., Byaruhanga, R., Labeja, O., Katundu, P., Tugume, S., Awio, P., Namazzi, A., Bakeinyaga, G. T., Katabira, H., Abaine, D., Tukamushaba, J., Anywar, W., Ojiambo, W., Angweng, E., Murungi, S., Haguma, W., Atwiine, S., Kigozi, J., Latif, A., Hakim, J., Robertson, V., Reid, A., Chidziva, E., Bulaya-Tembo, R., Musoro, G., Taziwa, F., Chimbetete, C., Chakonza, L., Mawora, A., Muvirimi, C., Tinago, G., Svovanapasis, P., Simango, M., Chirema, O., Machingura, J., Mutsai, S., Phiri, M., Bafana, T., Muchabaiwa, L., Muzambi, M., Katabira, E., Ronald, A., Kambungu, A., Lutwama, F., Nanfuka, A., Walusimbi, J., Nabankema, E., Nalumenya, R., Namuli, T., Kulume, R., Namata, I., Nyachwo, L., Florence, A., Kusiima, A., Lubwama, E., Nairuba, R., Oketta, F., Buluma, E., Waita, R., Ojiambo, H., Sadik, F., Wanyama, J., Nabongo, P., Ochai, R., Muhweezi, D., Gilks, C., Boocock, K., Puddephatt, C., Winogron, D., Bohannon, J., Darbyshire, J., Gibb, D. M., Burke, A., Bray, D., Babiker, A., Walker, A. S., Wilkes, H., Rauchenberger, M., Sheehan, S., Peto, L., Taylor, K., Spyer, M., Ferrier, A., Naidoo, B., Dunn, D., Nanfuka, R., Mufuka-Kapuya, C., Weller, I., Babiker, A., Bahendeka, S., Bassett, M., Chogo Wapakhabulo, A., Darbyshire, J., Gazzard, B., Gilks, C., Grosskurth, H., Hakim, J., Latif, A., Mapuchere, C., Mugurungi, O., Mugyenyi, P., Burke, C., Distel, M., Jones, S., Loeliger, E., Naidoo, P., Newland, C., Pearce, G., Rahim, S., Rooney, J., Smith, M., Snowden, W., Steens, J. -M., Ait-Khaled, M., Breckenridge, A., McLaren, A., Hill, C., Matenga, J., Pozniak, A., Serwadda, D., Peto, T., Palfreeman, A., Borok, M. and Katabira, E. (2017) 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, 17 1: . doi:10.1186/s12879-017-2266-3


Author Dolling, David I.
Goodall, Ruth L.
Chirara, Michael
Hakim, James
Nkurunziza, Peter
Munderi, Paula
Eram, David
Tumukunde, Dinah
Spyer, Moira J.
Gilks, Charles F.
Kaleebu, Pontiano
Dunn, David T.
Pillay, Deenan
Kaleebu, P.
Pillay, D.
Awio, P.
Dunn, D.
Gibb, D. M.
Gilks, C.
Kapaata, A.
Katuramur, M.
Lyagoba, F.
Magambo, B.
Mataruka, K.
Mugarura, L.
Musunga, T.
Nabankkema, M.
Nkalubo, J.
Nkurunziza, P.
Parry, C.
Robertson, V.
Spyer, M.
Mulima, D.
Williams, D. E.
Nankya, I.
Nassimbwa, S.
Ndashimye, E.
Nabulime, E.
Phiri, M.
Mutasa, K.
Mukasa, S.
Grosskurth, H.
Munderi, P.
Kabuye, G.
Nsibambi, D.
Kasirye, R.
Zalwango, E.
Nakazibwe, M.
Kikaire, B.
Nassuna, G.
Massa, R.
Fadhiru, K.
Namyalo, M.
Zalwango, A.
Generous, L.
Khauka, P.
Rutikarayo, N.
Nakahima, W.
Mugisha, A.
Todd, J.
Levin, J.
Muyingo, S.
Ruberantwari, A.
Kaleebu, P.
Yirrell, D.
Ndembi, N.
Lyagoba, F.
Hughes, P.
Aber, M.
Medina Lara, A.
Foster, S.
Amurwon, J.
Nyanzi Wakholi, B.
Mugyenyi, P.
Kityo, C.
Ssali, F.
Tumukunde, D.
Otim, T.
Kabanda, J.
Musana, H.
Akao, J.
Kyomugisha, H.
Byamukama, A.
Sabiiti, J.
Komugyena, J.
Wavamunno, P.
Mukiibi, S.
Drasiku, A.
Byaruhanga, R.
Labeja, O.
Katundu, P.
Tugume, S.
Awio, P.
Namazzi, A.
Bakeinyaga, G. T.
Katabira, H.
Abaine, D.
Tukamushaba, J.
Anywar, W.
Ojiambo, W.
Angweng, E.
Murungi, S.
Haguma, W.
Atwiine, S.
Kigozi, J.
Latif, A.
Hakim, J.
Robertson, V.
Reid, A.
Chidziva, E.
Bulaya-Tembo, R.
Musoro, G.
Taziwa, F.
Chimbetete, C.
Chakonza, L.
Mawora, A.
Muvirimi, C.
Tinago, G.
Svovanapasis, P.
Simango, M.
Chirema, O.
Machingura, J.
Mutsai, S.
Phiri, M.
Bafana, T.
Muchabaiwa, L.
Muzambi, M.
Katabira, E.
Ronald, A.
Kambungu, A.
Lutwama, F.
Nanfuka, A.
Walusimbi, J.
Nabankema, E.
Nalumenya, R.
Namuli, T.
Kulume, R.
Namata, I.
Nyachwo, L.
Florence, A.
Kusiima, A.
Lubwama, E.
Nairuba, R.
Oketta, F.
Buluma, E.
Waita, R.
Ojiambo, H.
Sadik, F.
Wanyama, J.
Nabongo, P.
Ochai, R.
Muhweezi, D.
Gilks, C.
Boocock, K.
Puddephatt, C.
Winogron, D.
Bohannon, J.
Darbyshire, J.
Gibb, D. M.
Burke, A.
Bray, D.
Babiker, A.
Walker, A. S.
Wilkes, H.
Rauchenberger, M.
Sheehan, S.
Peto, L.
Taylor, K.
Spyer, M.
Ferrier, A.
Naidoo, B.
Dunn, D.
Nanfuka, R.
Mufuka-Kapuya, C.
Weller, I.
Babiker, A.
Bahendeka, S.
Bassett, M.
Chogo Wapakhabulo, A.
Darbyshire, J.
Gazzard, B.
Gilks, C.
Grosskurth, H.
Hakim, J.
Latif, A.
Mapuchere, C.
Mugurungi, O.
Mugyenyi, P.
Burke, C.
Distel, M.
Jones, S.
Loeliger, E.
Naidoo, P.
Newland, C.
Pearce, G.
Rahim, S.
Rooney, J.
Smith, M.
Snowden, W.
Steens, J. -M.
Ait-Khaled, M.
Breckenridge, A.
McLaren, A.
Hill, C.
Matenga, J.
Pozniak, A.
Serwadda, D.
Peto, T.
Palfreeman, A.
Borok, M.
Katabira, E.
Title 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
Journal name BMC Infectious Diseases   Check publisher's open access policy
ISSN 1471-2334
Publication date 2017-02-21
Sub-type Article (original research)
DOI 10.1186/s12879-017-2266-3
Open Access Status DOI
Volume 17
Issue 1
Total pages 10
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2018
Language eng
Formatted abstract
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.
Keyword HIV-infected adults
Low-income
Resource-limited
Treatment outcomes
Virological failure
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Public Health Publications
 
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