immunologic response and HIV

Measures of site resourcing predict virologic suppression, immunologic response and HIV disease progression following highly active antiretroviral therapy (HAART) in the TREAT Asia HIV Observational Database (TAHOD).

Surrogate markers of HIV disease progression are HIV RNA in plasma viral load and CD4 cell count (immune function). Despite improved international access to antiretrovirals, surrogate marker diagnostics are not routinely available in resource-limited settings. Therefore, the objective was to assess effects of economic and diagnostic resourcing on patient treatment outcomes. Analyses were based on 2333 patients initiating antiretroviral therapy from 2000 onwards. Sites were categorized by World Bank country income criteria (high/low) and annual frequency of plasma viral load (>/=3, 1-2 or <1)>/=3 or <3)>Increased disease progression was associated with site-reported plasma viral load testing less than once per year [hazard ratio (HR)=1.4; P=0.032], severely symptomatic HIV infection (HR=1.4; P=0.003) and hepatitis C virus coinfection (HR=1.8; P=0.011). A total of 1120 patients (48.2%) had change in CD4 cell count data. Smaller increases were associated with older age (P<0.001) p="0.043)." or="0.28;">35% increase in disease progression in patients from sites with plasma viral load testing less than once per year.

Editor’s note: Setting out to determine the extent to which clinical resourcing affected patient outcomes in 17 clinical sites in Asia, this observational study followed 2333 patients. An increased risk of disease progression was found for patients at sites reporting that viral load testing was performed less than once a year, with a 35% increased risk of developing AIDS or dying. Rather than using viral load testing to monitor treatment efficacy, it is possible that, in the face of resource constraints, clinics were using viral load testing to confirm treatment failure. Lack of viral load testing increases the likelihood that patients will be maintained on failing regimens and develop highly resistant HIV. Expanding access to viral load testing and developing cheaper viral load tests that can be used more frequently to monitor treatment outcomes is an urgent global priority as access to antiretroviral therapy continues to expand.