Durability of viral suppression with first-line antiretroviral therapy in patients with HIV in the UK: an observational cohort study

O'Connor, Jemma; Chadwick, David; Dunn, David; Winston, Alan; Post, Frank A.; Allan, Sris; Babiker, Abdel; Delpech, Valerie; Fisher, Martin; Gilson, Richard; Hay, Phillip; Pillay, Deenan; Sachikonye, Memory; Trevelion, Roy; Glabay, Adam; Perry, Nicky; Tilbury, Stuart; Youssef, Elaney; Churchill, Duncan; Gazzard, Brian; Nelson, Mark; Everett, Russell J.; Asboe, David; Mandalia, Sundhiya; Korat, H; Taylor, Chris; Gleisner, Zachary; Ibrahim, Fowzia; Campbell, Lucy; Gilson, Richard; Brima, Nataliya; Williams, Ian; Johnson, Margaret; Youle, Mike; Lampe, F; Smith, Colette; Tsintas, R; Chaloner, Clinton; Hutchinson, S; Sabin, Caroline; Phillips, Andrew; Hill, Teresa; José, Sophie; Thornton, Alicia; Huntington, Susie; Walsh, John; Mackie, Nicky; Weber, Jonathan; Ramzan, F; Carder, Mark; Orkin, Chloe; Lynch, Janet R.; Hand, James M.; Souza, Carl de; Anderson, Jane; Munshi, Sajid; Ainsworth, Jonathan; Schwenk, Achim; Miller, Sheila; Wood, Chris; Leen, Clifford; Wilson, Alan C.; Morris, Sheila; Gompels, Mark; Allan, Sue; Palfreeman, Adrian; Memon, Khairuddin; Lewszuk, Adam; Cope, Elizabeth; Gibson, James J.; Kegg, Stephen; Main, Patricia A.; Mitchell, Sue; Hunter, Matthew; Dhillon, Mandeep Singh; Martin, Fabiola; Russell‐Sharpe, Sarah; Harte, A; Clay, Shondra Loggins; Tariq, Anjum; Spencer, Hazel; Jones, Ron; Pritchard, Jillian; Cumming, Shirley; Atkinson, Claire; Delpech, Valérie

doi:10.1016/s2352-3018(17)30053-x

Cited by 59 publications

(66 citation statements)

References 26 publications

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“…Our study also demonstrates that other factors such as duration of ART and adherence to ART were associated with the viral load. Similar to our research, longer duration on ART and high adherence to ART drugs were found to be associated with viral suppression or a lower level of viral load in different studies [25,[30][31][32][33]. This association implies the effectiveness of ART in improving the immune system.…”

Section: Discussionsupporting

confidence: 88%

Dental Caries in Association With Viral Load in Children Living With HIV in Phnom Penh, Cambodia

Kikuchi¹,

Yasuoka

Tuot³

et al. 2020

Preprint

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Abstract Background: Oral health status is known to be associated with overall health among people living with HIV. However, it is unclear whether dental caries is associated with viral load among this population. In particular, dental caries among children living with HIV needs to be better understood, as this can affect their overall health and well-being in future. This study assessed the association between dental caries and viral load among children living with HIV in Phnom Penh, Cambodia. Methods: This cross-sectional study was conducted at the National Paediatric Hospital as a baseline survey of a randomized controlled trial. The study population included children living with HIV aged 3–15 years and their primary caregivers. We collected data on the children’s oral health status by oral examination and the latest HIV viral load data stored in the patients’ information system of the hospital. Multiple logistic regression analysis was conducted to assess association between dental caries and viral load. The cut-off point of undetectable viral load was set at <40 copies/mL. Results: Data from 328 children were included in the analyses. Moreover, 68.3% had an undetectable viral load. The mean number of permanent or deciduous teeth with caries was 7.7 (standard deviation [SD], 5.0). In the regression analysis, dental caries in permanent or deciduous teeth were positively associated with detectable viral load (adjusted odds ratio [AOR]: 1.07, 95% confidence interval [CI]: 1.01, 1.14). Having received antiretroviral therapy ≥1 year and self-reported excellent adherence to the antiretroviral drug were also negatively associated with detectable viral load. Among children with detectable levels of viral load, dental caries in permanent or deciduous teeth were also positively associated with non-suppression of viral load (>1000 copies/mL) (AOR: 1.12, 95% CI: 1.03, 1.23). Conclusions: Dental caries was associated with viral load status detection among children living with HIV. This finding suggests that oral health status may affect the immune status of the children. Oral health of children living with HIV should be strengthened, and further research is needed to clarify the causal relationship between viral load and oral health status.

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Section: Discussionsupporting

confidence: 88%

Dental Caries in Association With Viral Load in Children Living With HIV in Phnom Penh, Cambodia

Kikuchi¹,

Yasuoka

Tuot³

et al. 2020

Preprint

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“…VL = viral load; ART = antiretroviral therapy; AIC = Akaike information criterion; the lower the value of the AIC, the better model fit. 1,2 Main predictors VLs at 1 and 3 month fitted on logarithmic scale (see methods). 2 Adjusted for age (continuous), ethnicity and gender/likely risk for HIV acquisition, and treatment regimen.…”

Section: Resultsmentioning

confidence: 99%

Early virological response to HIV treatment: can we predict who is likely to experience subsequent treatment failure? Results from an observational cohort study, London, UK

Brima¹,

Lampe²,

Copas³

et al. 2017

Journal of the International AIDS Society

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Introduction: For people living with HIV, the first antiretroviral treatment (ART) regimen offers the best chance for a good virological response. Early identification of those unlikely to respond to first-line ART could enable timely intervention and increase chances of a good initial treatment response. In this study we assess the extent to which the HIV RNA viral load (VL) at 1 and 3 months is predictive of first-line treatment outcome at 6 months. Methods: All previously ART-naive individuals starting ART at two London centres since 2000 with baseline (−180 to 3 days) VL >500 c/mL had a VL measurement between 6 and 12 months after starting ART, and at least one at month 1 (4-60 days) or month 3 (61-120 days) were included. Lack of treatment response was defined as (i) VL >200 copies/mL at 6 months or (ii) VL >200 copies/mL at 6 months or simultaneous switch in drugs from at least two different drug classes before 6 months. The association with VL measurements at 1 and 3 months post-ART; change from pre-ART in these values; and CD4 count measurements at 1 and 3 months were assessed using logistic regression models. The relative fit of the models was compared using the Akaike information criterion (AIC). Results: A total of 198 out of 3258 individuals (6%) experienced lack of treatment response at 6 months (definition i), increasing to 511 (16%) for definition (ii). Those with a 1-month (day 4-60 window) VL of <1000, 1000-9999, 10,000-99,999 and >100,000 copies/ml had a 4%, 8%, 23% and 24% chance, respectively, of subsequently experiencing treatment non-response at 6 months (definition (i)). When considering the 3-month (day 61-120 window) VL, the chances of subsequently experiencing treatment non-response were, respectively, 3%, 25%, 67% and 75%. Results were similar for definition (ii). Conclusions: Whilst 3-month VL provides good discrimination between low and high risk of treatment failure, 1-month VL does not. Presence of a VL >10,000 copies/ml after 3 months of ART is a cutoff above which individuals are at a sufficiently higher risk of non-response that they may be considered for intervention.

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“…The second approach to cost estimation (model 2) used the same HARS data to inform when a person entered the model from diagnosis to ART initiation. However, subsequent changes to the ART regime were based on the annual rate of primary ART failure as reported by the UK CHIC cohort study . The annual rate of primary viral rebound was based on data for 16 101 persons who started ART between January 1998 and May 2013 .…”

Section: Methodsmentioning

confidence: 99%

“…However, subsequent changes to the ART regime were based on the annual rate of primary ART failure as reported by the UK CHIC cohort study . The annual rate of primary viral rebound was based on data for 16 101 persons who started ART between January 1998 and May 2013 . In those with primary viral rebound following first‐line ART, model 2 assumed that the proportional distribution of those given second‐ or subsequent‐line or complex ARV followed the proportional distribution of patients by treatment complexity level as recorded in HARS.…”

Section: Methodsmentioning

confidence: 99%

HIV care cost in England: a cross‐sectional analysis of antiretroviral treatment and the impact of generic introduction

et al. 2019

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ObjectivesReliable and timely HIV care cost estimates are important for policy option appraisals of HIV treatment and prevention strategies. As HIV clinical management and outcomes have changed, we aimed to update profiles of antiretroviral (ARV) usage pattern, patent/market exclusivity details and management costs in adults (≥ 18 years old) accessing HIV specialist care in England. MethodsThe data reported quarterly to the HIV and AIDS Reporting System in England was used to identify ARV usage pattern, and were combined with British National Formulary (BNF) prices, non-ARV care costs and patent/market exclusivity information to generate average survival-adjusted lifetime care costs. The cumulative budget impact from 2018 to the year in which all current ARVs were expected to lose market exclusivity was calculated for a hypothetical 85 000 (AE 5000) person cohort, which provided an illustration of potential financial savings afforded by bioequivalent generic switches. Price scenarios explored BNF70 (September 2015) prices and generics at 10/20/ 30/50% of proprietary prices. The analyses took National Health Service (NHS) England's perspective (as the payer), and results are presented in 2016/2017 British pounds.

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Durability of viral suppression with first-line antiretroviral therapy in patients with HIV in the UK: an observational cohort study

Cited by 59 publications

References 26 publications

Dental Caries in Association With Viral Load in Children Living With HIV in Phnom Penh, Cambodia

Dental Caries in Association With Viral Load in Children Living With HIV in Phnom Penh, Cambodia

Early virological response to HIV treatment: can we predict who is likely to experience subsequent treatment failure? Results from an observational cohort study, London, UK

HIV care cost in England: a cross‐sectional analysis of antiretroviral treatment and the impact of generic introduction

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