Outcomes of antiretroviral treatment in programmes with and without routine viral load monitoring in southern Africa

• DOI: 10.1097/qad.0b013e328349822f
• Publication Date: 2011-06-16T20:57:37Z
• Authors: Olivia Keiser; Benjamin H. Chi; Thomas Gsponer; Andrew Boulle; Catherine Orrell; Sam Phiri; Nicola Maxwell; Mhairi Maskew; Hans Prozesky; Matthew P. Fox; Andrew Westfall; Matthias Egger
• Keywords: Regimen

To compare outcomes of antiretroviral therapy (ART) in South Africa, where viral load monitoring is routine, with those Malawi and Zambia, based on CD4 cell counts.We included 18,706 adult patients starting ART Africa 80,937 Zambia or Malawi. We examined responses models for repeated measures the probability switching to second-line regimens, mortality loss follow-up multistate models, measuring time from 6 months.In 9.8% [95% confidence interval (CI) 9.1-10.5] had switched at 3 years, 1.3% (95% CI 0.9-1.6) remained failing first-line 9.2% 8.5-9.8) were lost 4.3% 3.9-4.8) died. In more a regimen [3.7% 3.6-3.9], fewer [2.1% 2.0-2.3)] [15.3% 15.0-15.6)] died [6.3% 6.0-6.5)]. Median counts lower start (93 vs. 132 cells/μl; P < 0.001) but higher after years (425 383 0.001). The hazard ratio comparing adjusting age, sex, count was 0.58 (0.50-0.66) death 0.53 (0.48-0.58) follow-up.Over than Zambia. favourable outcome might be explained by leading earlier detection treatment failure, adherence counselling timelier ART.