Clinical and socio-demographic predictors for virologic failure in rural Southern Africa: preliminary findings from CART-1

Labhardt, Niklaus Daniel and Bader, Joëlle and Ramoeletsi, Mojakisane and Kamele, Mashaete and Lejone, Thabo Ishmael and Cheleboi, Molisana and Motlatsi, Mokete M. and Ehmer, Jochen and Faturyiele, Olatunbosun and Puga, Daniel and Klimkait, Thomas. (2014) Clinical and socio-demographic predictors for virologic failure in rural Southern Africa: preliminary findings from CART-1. Journal of the International AIDS Society, 17 (4 Suppl 3). p. 19666.

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Official URL: https://edoc.unibas.ch/62194/

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INTRODUCTION: In 2013, the World Health Organization (WHO) recommended scaling up of routine viral load (VL) monitoring for patients on antiretroviral therapy (ART) in resource-limited settings [1]. During the transition phase from no VL-testing at all to routine VL-monitoring, targeted VL for groups at particular risk of virologic failure (VF) may be an option [2]. We present socio-demographic and clinical risk factors for VF in a cohort in rural Lesotho with no access to VL prior to the study. MATERIALS AND METHODS: Data derive from a cross-sectional study providing multi-disease screening as well as VL testing to adult patients (</=16 years old) on first-line ART </=6 months [3]. VF was defined as VL</=1000 copies/mL. Assessed potential predictors of VF were: (1) socio-demographic (sex, age, wealth-quintile, education, employment status, disclosure of HIV status to environment, travel-time to facility); (2) treatment history (history of treatment interruption <2 days, previous drug substitution within first-line ART, time on ART, ART-base and -backbone); (3) adherence (pill count) and (4) clinical (clinical or immunological failure as defined by WHO guidelines [1], presence of papular pruritic eruption (PPE)). All variables with association to VF in univariate analysis were included in a multivariate logistic regression reporting adjusted Odds ratios (aOR). RESULTS: Data from 1,488 patients were analyzed. Overall VF-prevalence was 6.9% (95% CI 5.7-8.3). In univariate analysis, the following were associated with VF: age /=2 hours, disclosure of HIV status to >5 persons, clinical failure, presence of PPE and immunological failure. In multivariate analysis, 6 out of the above 12 variables were independent predictors: age >30 years (aOR: 2.4; 95% CI 1.1-5.3, p=0.029), history of treatment interruption (2.5; 1.3-4.7, p=0.005), PPE (6.9; 2.5-18.9, p>0.001), immunological failure (11.5; 5.7-23.2, p>0.001), history of drug substitution (1.9; 1.0-3.7, p=0.043), disclosure of HIV status to >5 persons (1.8; 1.1-3.1, p=0.03). CONCLUSION: In this cohort in rural Lesotho, several socio-demographic and clinical predictors were associated with VF. Particularly age >30 years, history of treatment interruption, PPE and immunological failure were strongly associated with VF. These patients may be prioritized for targeted VL-testing.
Faculties and Departments:03 Faculty of Medicine > Departement Biomedizin > Division of Medical Microbiology > Molecular Virology (Klimkait)
UniBasel Contributors:Klimkait, Thomas
Item Type:Article, refereed
Article Subtype:Research Article
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:28 Jul 2020 15:41
Deposited On:28 Jul 2020 15:41

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