Recent trends in adult and pediatric antiretroviral therapy monitoring and failure
Document Type
Article
Publication Date
6-1-2022
Abstract
Objective: To assess recent trends in the monitoring of antiretroviral therapy (ART) and detection of ART failure in adult and pediatric HIV clinics. Methods: We used data collected from 21 adult and 17 pediatric sites (across 13 and 6 countries/territories, respectively) in the International Epidemiology Databases to Evaluate AIDS - Asia-Pacific cohort. ART failure was defined as viral, immune, or clinical consistent with WHO guidelines. Results: A total of 8567 adults and 6149 children contributed data. Frequency of CD4 count monitoring declined between 2010 and 2019 among adult sites (from 1.93 to 1.06 tests/person per year, a 45.1% decline) and pediatric sites (from 2.16 to 0.86 testsperson per year, a 60.2% decline), whereas rates of viral load monitoring remained relatively stable. The proportion of adult and pediatric treatment failure detected as immune failure declined (from 73.4% to 50.0% and from 45.8% to 23.1%, respectively), whereas the proportion of failure detected as viral failure increased (from 7.8% to 25.0% and from 45.8% to 76.9%, respectively). The proportion of ART failure detected as clinical failure remained stable among adult and pediatric sites. The largest shifts in ART monitoring and failure type occurred in lower middle-income countries. Conclusions: Although viral failure in our Asian cohort now comprises a larger portion of ART failure than in prior years, the diagnostic characteristics of immune and clinical failure, and recommendations on their management, remain important inclusions for regional ART guidelines.
Keywords
HIV, Antiretroviral therapy, Viral load, CD4, Treatment failure, Asia
Divisions
medicinedept
Funders
National Institutes of Health (NIH) - USA NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK),Fogarty International Center, as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA) U01AI069907,Australian Government Department of Health & Ageing,Gilead Sciences,National Health and Medical Research Council (NHMRC) of Australia APP1140503
Publication Title
Journal of Acquired Immune Deficiency Syndromes
Volume
90
Issue
2
Publisher
Lippincott, Williams & Wilkins
Publisher Location
TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA