An Expanded HIV Care Cascade: ART Uptake, Viral Load Suppression and Comorbidity Monitoring among Adults Living with HIV in Asia

Abstract

Background: Comprehensive treatment and clinical management are central to improving outcomes for people living with HIV (PLHIV). We explored trends in HIV clinical care, treatment outcomes, and chronic kidney disease (CKD) and diabetes monitoring. Methods: We included patients ≥18 years in care at ten clinical sites in eight Asian countries. Proportions of patients on antiretroviral therapy (ART), with annual viral load, and with viral load suppression (VLS; <1,000 copies/ml) were estimated by year for 2011- 2016, stratified by country income level (lower-middle income [LMIC] and high-income countries [HIC]). Among those on ART in 2016 we evaluated factors associated with annual CKD and diabetes monitoring.Results: Among 31,346 patients (67% male), the proportions of patients on ART (median ART initiation year 2011, IQR 2007-2013), with annual viral load and VLS had substantially increased by 2016 (to 94%, 42% and 92%, respectively, in LMIC and 95%, 97% and 93%, respectively, in HIC) with the larger increases over time seen in LMIC. Among those on ART in 2016, monitoring proportions in LMIC were 53% for CKD and 26% for diabetes compared with 83% and 59%, respectively, in HIC. Overall, a decreased odds of monitoring was observed for male gender, heterosexual HIV exposure, no viral load and LMIC. Diabetes monitoring was also decreased in those with viral failure. Conclusions: Our findings highlight suboptimal monitoring of viral load, CKD and diabetes in PLHIV in Asia. There is a need for affordable and scalable monitoring options to improve the joint care for HIV and non-communicable diseases.Goals in the fight against HIV have transformed over time in line with the changing epidemic and improved treatment options. Following the scale up of effective antiretroviral therapy (ART), the current focus is on ending AIDS as a public health threat [1], which entails reducing the global HIV incidence to 200,000 or fewer new cases a year [2]. Landmark studies have shown that ART initiation in earlier stages of HIV infection,

Virological failure among people living with HIV receiving second-line antiretroviral therapy in Pune, India

“…However, in many LMICs, the regularity of VL testing remains suboptimal. A recent study from Asia of 31,346 PLHIV (with > 60% of the data originating from India) showed that VL testing was performed less than annually in > 50% of PLHIV [ 17 ]. At present, NACO recommends CD4 monitoring among adult PLHIV on second-line ART with CD4 count < 350 cells/mm 3 in addition to 6-monthly VL testing [ 6 , 7 ].…”

Trends in the burden and determinants of HIV in the Asia‐Pacific region (1990−2019): An age‐period‐cohort analysis of the 2019 Global Burden of Disease Study

“…To the best of our knowledge, this is the first study of its kind. Previous studies on the AIDS epidemic in the Asia-Pacific region, [23][24][25][26] particularly Jong et al, observed that the rates of AIDSrelated and non-AIDS-related mortality in the Asia-Pacific cohorts decreased from 1999 to 2018 and that the risk for non-AIDSassociated deaths was higher in the high-income countries, compared to the lower-middle income countries. 26 In contrast, we found that the HIV burden in the Asia-Pacific region was highest in the low SDI group, and the incidence of HIV was highest among those in the 20−30 years age group.…”

Synthesis and the application of molecularly imprinted polymers as solid-phase extraction and dispersive solid-phase extraction sorbents in the extraction of antiretroviral drugs in water.

“…A study conducted by Mckinney and colleagues showed that zidovudine exposure to children can cause anaemia and lactic acidosis which may affect breathing patterns (Mckinney et al,1991). Long term survivors of HIV who were through antiretroviral therapy (ART) showed several pathologies such as metabolic, lipid, cardiovascular and neurological disorders (Bijker et al, 2020). Another study conducted by Bertrand and colleagues showed that long term use of ART may result in cerebral vascular toxicity (Bertrand et al, 2019).…”