Viraemic-time predicts mortality among people living with HIV on second-line antiretroviral treatment in Myanmar: A retrospective cohort study.
<h4>Introduction</h4>Despite HIV viral load (VL) monitoring being serial, most studies use a cross-sectional design to evaluate the virological status of a cohort. The objective of our study was to use a simplified approach to calculate viraemic-time: the proportion of follow-up time wit...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2022-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0271910 |
| _version_ | 1811308707326197760 |
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| author | Anita Mesic Tom Decroo Htay Thet Mar Bart K M Jacobs Moe Pyae Thandar Thin Thin Thwe Aung Aung Kyaw Mitchell Sangma David Beversluis Elkin Bermudez-Aza Alexander Spina Darli Po Po Aung Erwan Piriou Koert Ritmeijer Josefien Van Olmen Htun Nyunt Oo Lutgarde Lynen |
| author_facet | Anita Mesic Tom Decroo Htay Thet Mar Bart K M Jacobs Moe Pyae Thandar Thin Thin Thwe Aung Aung Kyaw Mitchell Sangma David Beversluis Elkin Bermudez-Aza Alexander Spina Darli Po Po Aung Erwan Piriou Koert Ritmeijer Josefien Van Olmen Htun Nyunt Oo Lutgarde Lynen |
| author_sort | Anita Mesic |
| collection | DOAJ |
| description | <h4>Introduction</h4>Despite HIV viral load (VL) monitoring being serial, most studies use a cross-sectional design to evaluate the virological status of a cohort. The objective of our study was to use a simplified approach to calculate viraemic-time: the proportion of follow-up time with unsuppressed VL above the limit of detection. We estimated risk factors for higher viraemic-time and whether viraemic-time predicted mortality in a second-line antiretroviral treatment (ART) cohort in Myanmar.<h4>Methods</h4>We conducted a retrospective cohort analysis of people living with HIV (PLHIV) who received second-line ART for a period >6 months and who had at least two HIV VL test results between 01 January 2014 and 30 April 2018. Fractional logistic regression assessed risk factors for having higher viraemic-time and Cox proportional hazards regression assessed the association between viraemic-time and mortality. Kaplan-Meier curves were plotted to illustrate survival probability for different viraemic-time categories.<h4>Results</h4>Among 1,352 participants, 815 (60.3%) never experienced viraemia, and 172 (12.7%), 214 (15.8%), and 80 (5.9%) participants were viraemic <20%, 20-49%, and 50-79% of their total follow-up time, respectively. Few (71; 5.3%) participants were ≥80% of their total follow-up time viraemic. The odds for having higher viraemic-time were higher among people with a history of injecting drug use (aOR 2.01, 95% CI 1.30-3.10, p = 0.002), sex workers (aOR 2.10, 95% CI 1.11-4.00, p = 0.02) and patients treated with lopinavir/ritonavir (vs. atazanavir; aOR 1.53, 95% CI 1.12-2.10, p = 0.008). Viraemic-time was strongly associated with mortality hazard among those with 50-79% and ≥80% viraemic-time (aHR 2.92, 95% CI 1.21-7.10, p = 0.02 and aHR 2.71, 95% CI 1.22-6.01, p = 0.01). This association was not observed in those with viraemic-time <50%.<h4>Conclusions</h4>Key populations were at risk for having a higher viraemic-time on second-line ART. Viraemic-time predicts clinical outcomes. Differentiated services should target subgroups at risk for a higher viraemic-time to control both HIV transmission and mortality. |
| first_indexed | 2024-04-13T09:29:23Z |
| format | Article |
| id | doaj.art-c134a83953e7458a9275255d5d38afee |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-13T09:29:23Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj.art-c134a83953e7458a9275255d5d38afee2022-12-22T02:52:21ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01177e027191010.1371/journal.pone.0271910Viraemic-time predicts mortality among people living with HIV on second-line antiretroviral treatment in Myanmar: A retrospective cohort study.Anita MesicTom DecrooHtay Thet MarBart K M JacobsMoe Pyae ThandarThin Thin ThweAung Aung KyawMitchell SangmaDavid BeversluisElkin Bermudez-AzaAlexander SpinaDarli Po Po AungErwan PiriouKoert RitmeijerJosefien Van OlmenHtun Nyunt OoLutgarde Lynen<h4>Introduction</h4>Despite HIV viral load (VL) monitoring being serial, most studies use a cross-sectional design to evaluate the virological status of a cohort. The objective of our study was to use a simplified approach to calculate viraemic-time: the proportion of follow-up time with unsuppressed VL above the limit of detection. We estimated risk factors for higher viraemic-time and whether viraemic-time predicted mortality in a second-line antiretroviral treatment (ART) cohort in Myanmar.<h4>Methods</h4>We conducted a retrospective cohort analysis of people living with HIV (PLHIV) who received second-line ART for a period >6 months and who had at least two HIV VL test results between 01 January 2014 and 30 April 2018. Fractional logistic regression assessed risk factors for having higher viraemic-time and Cox proportional hazards regression assessed the association between viraemic-time and mortality. Kaplan-Meier curves were plotted to illustrate survival probability for different viraemic-time categories.<h4>Results</h4>Among 1,352 participants, 815 (60.3%) never experienced viraemia, and 172 (12.7%), 214 (15.8%), and 80 (5.9%) participants were viraemic <20%, 20-49%, and 50-79% of their total follow-up time, respectively. Few (71; 5.3%) participants were ≥80% of their total follow-up time viraemic. The odds for having higher viraemic-time were higher among people with a history of injecting drug use (aOR 2.01, 95% CI 1.30-3.10, p = 0.002), sex workers (aOR 2.10, 95% CI 1.11-4.00, p = 0.02) and patients treated with lopinavir/ritonavir (vs. atazanavir; aOR 1.53, 95% CI 1.12-2.10, p = 0.008). Viraemic-time was strongly associated with mortality hazard among those with 50-79% and ≥80% viraemic-time (aHR 2.92, 95% CI 1.21-7.10, p = 0.02 and aHR 2.71, 95% CI 1.22-6.01, p = 0.01). This association was not observed in those with viraemic-time <50%.<h4>Conclusions</h4>Key populations were at risk for having a higher viraemic-time on second-line ART. Viraemic-time predicts clinical outcomes. Differentiated services should target subgroups at risk for a higher viraemic-time to control both HIV transmission and mortality.https://doi.org/10.1371/journal.pone.0271910 |
| spellingShingle | Anita Mesic Tom Decroo Htay Thet Mar Bart K M Jacobs Moe Pyae Thandar Thin Thin Thwe Aung Aung Kyaw Mitchell Sangma David Beversluis Elkin Bermudez-Aza Alexander Spina Darli Po Po Aung Erwan Piriou Koert Ritmeijer Josefien Van Olmen Htun Nyunt Oo Lutgarde Lynen Viraemic-time predicts mortality among people living with HIV on second-line antiretroviral treatment in Myanmar: A retrospective cohort study. PLoS ONE |
| title | Viraemic-time predicts mortality among people living with HIV on second-line antiretroviral treatment in Myanmar: A retrospective cohort study. |
| title_full | Viraemic-time predicts mortality among people living with HIV on second-line antiretroviral treatment in Myanmar: A retrospective cohort study. |
| title_fullStr | Viraemic-time predicts mortality among people living with HIV on second-line antiretroviral treatment in Myanmar: A retrospective cohort study. |
| title_full_unstemmed | Viraemic-time predicts mortality among people living with HIV on second-line antiretroviral treatment in Myanmar: A retrospective cohort study. |
| title_short | Viraemic-time predicts mortality among people living with HIV on second-line antiretroviral treatment in Myanmar: A retrospective cohort study. |
| title_sort | viraemic time predicts mortality among people living with hiv on second line antiretroviral treatment in myanmar a retrospective cohort study |
| url | https://doi.org/10.1371/journal.pone.0271910 |
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