Global estimates of viral suppression in children and adolescents and adults on antiretroviral therapy adjusted for missing viral load measurements: a multiregional, retrospective cohort study in 31 countries.
Lancet HIV
; 8(12): e766-e775, 2021 12.
Article
em En
| MEDLINE
| ID: mdl-34856180
BACKGROUND: As countries move towards the UNAIDS's 95-95-95 targets and with strong evidence that undetectable equals untransmittable, it is increasingly important to assess whether those with HIV who are receiving antiretroviral therapy (ART) achieve viral suppression. We estimated the proportions of children and adolescents and adults with viral suppression at 1, 2, and 3 years after initiating ART. METHODS: In this retrospective cohort study, seven regional cohorts from the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium contributed data from individuals initiating ART between Jan 1, 2010, and Dec 31, 2019, at 148 sites in 31 countries with annual viral load monitoring. Only people with HIV who started ART after the time a site started routine viral load monitoring were included. Data up to March 31, 2020, were analysed. We estimated the proportions of children and adolescents (aged <18 years at ART initiation) and adults (aged ≥18 years at ART initiation) with viral suppression (viral load <1000 copies per mL) at 1, 2, and 3 years after ART initiation using an intention-to-treat approach and an adjusted approach that accounted for missing viral load measurements. FINDINGS: 21â594 children and adolescents (11â812 [55%] female, 9782 [45%] male) from 106 sites in 22 countries and 255â662 adults (163â831 [64%] female, 91â831 [36%] male) from 143 sites in 30 countries were included. Using the intention-to-treat approach, the proportion of children and adolescents with viral suppression was 7303 (36%) of 20â478 at 1 year, 5709 (30%) of 19â135 at 2 years, and 4287 (24%) of 17â589 at 3 years after ART initiation; the proportion of adults with viral suppression was 106â541 (44%) of 240â600 at 1 year, 79â141 (36%) of 220â925 at 2 years, and 57â970 (29%) of 201â124 at 3 years after ART initiation. After adjusting for missing viral load measurements among those who transferred, were lost to follow-up, or who were in follow-up without viral load testing, the proportion of children and adolescents with viral suppression was 12â048 (64% [plausible range 43-81]) of 18â835 at 1 year, 10â796 (62% [41-77]) of 17â553 at 2 years, and 9177 (59% [38-91]) of 15â667 at 3 years after ART initiation; the proportion of adults with viral suppression was 176â964 (79% [53-80]) of 225â418 at 1 year, 145â552 (72% [48-79]) of 201â238 at 2 years, and 115â260 (65% [43-69]) of 178â458 at 3 years after ART initiation. INTERPRETATION: Although adults with HIV are approaching the global target of 95% viral suppression, progress among children and adolescents is much slower. Substantial efforts are still needed to reach the viral suppression target for children and adolescents. FUNDING: US National Institutes of Health.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Infecções por HIV
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Fármacos Anti-HIV
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Observational_studies
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Risk_factors_studies
Limite:
Adolescent
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Adult
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Child
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Female
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Humans
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Male
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article