Long-term virological outcomes of first-line antiretroviral therapy for HIV-1 in low- and middle-income countries: A systematic review and meta-analysis

T. Sonia Boender, Kim C.E. Sigaloff, James H. Mcmahon, Sasisopin Kiertiburanakul, Michael R. Jordan, Jhoney Barcarolo, Nathan Ford, Tobias F. Rinke De Wit, Silvia Bertagnolio

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Background.More than 11.7 million people are currently receiving antiretroviral therapy (ART) in low- and middle-income countries (LMICs), and focused efforts are needed to ensure high levels of adherence and to minimize treatment failure. Recently, international targets have emphasized the importance of long-term virological suppression as a key measure of program performance. Methods.We systematically reviewed publications and conference abstracts published between January 2006 and May 2013 that reported virological outcomes among human immunodeficiency virus type 1 (HIV-1)-infected adults receiving first-line ART for up to 5 years in LMICs. Summary estimates of virological suppression after 6, 12, 24, 36, 48, and 60 months of ART were analyzed using random-effects meta-analysis. Intention-to-treat (ITT) analysis assumed all participants who were lost to follow-up, died, or stopped ART as having virological failure. Results.Summary estimates of virological suppression remained >80% for up to 60 months of ART for all 184 included cohorts. ITT analysis yielded 74.7% (95% confidence interval [CI], 72.2-77.2) suppression after 6 months and 61.8% (95% CI, 44.0-79.7) suppression after 48 months on ART. Switches to second-line ART were reported scarcely. Conclusions.Among individuals retained on ART, virological suppression rates during the first 5 years of ART were high (>80%) and stable. Suppression rates in ITT analysis declined during 4 years.

Original languageEnglish
Pages (from-to)1453-1461
Number of pages9
JournalClinical Infectious Diseases
Volume61
Issue number9
DOIs
Publication statusPublished - 1 Nov 2015

Cite this

Boender, T. Sonia ; Sigaloff, Kim C.E. ; Mcmahon, James H. ; Kiertiburanakul, Sasisopin ; Jordan, Michael R. ; Barcarolo, Jhoney ; Ford, Nathan ; Rinke De Wit, Tobias F. ; Bertagnolio, Silvia. / Long-term virological outcomes of first-line antiretroviral therapy for HIV-1 in low- and middle-income countries : A systematic review and meta-analysis. In: Clinical Infectious Diseases. 2015 ; Vol. 61, No. 9. pp. 1453-1461.
@article{b7d1fc2ec241457793396325671ac120,
title = "Long-term virological outcomes of first-line antiretroviral therapy for HIV-1 in low- and middle-income countries: A systematic review and meta-analysis",
abstract = "Background.More than 11.7 million people are currently receiving antiretroviral therapy (ART) in low- and middle-income countries (LMICs), and focused efforts are needed to ensure high levels of adherence and to minimize treatment failure. Recently, international targets have emphasized the importance of long-term virological suppression as a key measure of program performance. Methods.We systematically reviewed publications and conference abstracts published between January 2006 and May 2013 that reported virological outcomes among human immunodeficiency virus type 1 (HIV-1)-infected adults receiving first-line ART for up to 5 years in LMICs. Summary estimates of virological suppression after 6, 12, 24, 36, 48, and 60 months of ART were analyzed using random-effects meta-analysis. Intention-to-treat (ITT) analysis assumed all participants who were lost to follow-up, died, or stopped ART as having virological failure. Results.Summary estimates of virological suppression remained >80{\%} for up to 60 months of ART for all 184 included cohorts. ITT analysis yielded 74.7{\%} (95{\%} confidence interval [CI], 72.2-77.2) suppression after 6 months and 61.8{\%} (95{\%} CI, 44.0-79.7) suppression after 48 months on ART. Switches to second-line ART were reported scarcely. Conclusions.Among individuals retained on ART, virological suppression rates during the first 5 years of ART were high (>80{\%}) and stable. Suppression rates in ITT analysis declined during 4 years.",
keywords = "antiretroviral therapy, HIV-1, low- and middle-income countries, virological monitoring",
author = "Boender, {T. Sonia} and Sigaloff, {Kim C.E.} and Mcmahon, {James H.} and Sasisopin Kiertiburanakul and Jordan, {Michael R.} and Jhoney Barcarolo and Nathan Ford and {Rinke De Wit}, {Tobias F.} and Silvia Bertagnolio",
year = "2015",
month = "11",
day = "1",
doi = "10.1093/cid/civ556",
language = "English",
volume = "61",
pages = "1453--1461",
journal = "Clinical infectious diseases : an official publication of the Infectious Diseases Society of America",
issn = "1058-4838",
number = "9",

}

Boender, TS, Sigaloff, KCE, Mcmahon, JH, Kiertiburanakul, S, Jordan, MR, Barcarolo, J, Ford, N, Rinke De Wit, TF & Bertagnolio, S 2015, 'Long-term virological outcomes of first-line antiretroviral therapy for HIV-1 in low- and middle-income countries: A systematic review and meta-analysis' Clinical Infectious Diseases, vol. 61, no. 9, pp. 1453-1461. https://doi.org/10.1093/cid/civ556

Long-term virological outcomes of first-line antiretroviral therapy for HIV-1 in low- and middle-income countries : A systematic review and meta-analysis. / Boender, T. Sonia; Sigaloff, Kim C.E.; Mcmahon, James H.; Kiertiburanakul, Sasisopin; Jordan, Michael R.; Barcarolo, Jhoney; Ford, Nathan; Rinke De Wit, Tobias F.; Bertagnolio, Silvia.

In: Clinical Infectious Diseases, Vol. 61, No. 9, 01.11.2015, p. 1453-1461.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - Long-term virological outcomes of first-line antiretroviral therapy for HIV-1 in low- and middle-income countries

T2 - A systematic review and meta-analysis

AU - Boender, T. Sonia

AU - Sigaloff, Kim C.E.

AU - Mcmahon, James H.

AU - Kiertiburanakul, Sasisopin

AU - Jordan, Michael R.

AU - Barcarolo, Jhoney

AU - Ford, Nathan

AU - Rinke De Wit, Tobias F.

AU - Bertagnolio, Silvia

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Background.More than 11.7 million people are currently receiving antiretroviral therapy (ART) in low- and middle-income countries (LMICs), and focused efforts are needed to ensure high levels of adherence and to minimize treatment failure. Recently, international targets have emphasized the importance of long-term virological suppression as a key measure of program performance. Methods.We systematically reviewed publications and conference abstracts published between January 2006 and May 2013 that reported virological outcomes among human immunodeficiency virus type 1 (HIV-1)-infected adults receiving first-line ART for up to 5 years in LMICs. Summary estimates of virological suppression after 6, 12, 24, 36, 48, and 60 months of ART were analyzed using random-effects meta-analysis. Intention-to-treat (ITT) analysis assumed all participants who were lost to follow-up, died, or stopped ART as having virological failure. Results.Summary estimates of virological suppression remained >80% for up to 60 months of ART for all 184 included cohorts. ITT analysis yielded 74.7% (95% confidence interval [CI], 72.2-77.2) suppression after 6 months and 61.8% (95% CI, 44.0-79.7) suppression after 48 months on ART. Switches to second-line ART were reported scarcely. Conclusions.Among individuals retained on ART, virological suppression rates during the first 5 years of ART were high (>80%) and stable. Suppression rates in ITT analysis declined during 4 years.

AB - Background.More than 11.7 million people are currently receiving antiretroviral therapy (ART) in low- and middle-income countries (LMICs), and focused efforts are needed to ensure high levels of adherence and to minimize treatment failure. Recently, international targets have emphasized the importance of long-term virological suppression as a key measure of program performance. Methods.We systematically reviewed publications and conference abstracts published between January 2006 and May 2013 that reported virological outcomes among human immunodeficiency virus type 1 (HIV-1)-infected adults receiving first-line ART for up to 5 years in LMICs. Summary estimates of virological suppression after 6, 12, 24, 36, 48, and 60 months of ART were analyzed using random-effects meta-analysis. Intention-to-treat (ITT) analysis assumed all participants who were lost to follow-up, died, or stopped ART as having virological failure. Results.Summary estimates of virological suppression remained >80% for up to 60 months of ART for all 184 included cohorts. ITT analysis yielded 74.7% (95% confidence interval [CI], 72.2-77.2) suppression after 6 months and 61.8% (95% CI, 44.0-79.7) suppression after 48 months on ART. Switches to second-line ART were reported scarcely. Conclusions.Among individuals retained on ART, virological suppression rates during the first 5 years of ART were high (>80%) and stable. Suppression rates in ITT analysis declined during 4 years.

KW - antiretroviral therapy

KW - HIV-1

KW - low- and middle-income countries

KW - virological monitoring

UR - http://www.scopus.com/inward/record.url?scp=84946731866&partnerID=8YFLogxK

U2 - 10.1093/cid/civ556

DO - 10.1093/cid/civ556

M3 - Review article

VL - 61

SP - 1453

EP - 1461

JO - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

SN - 1058-4838

IS - 9

ER -