Detection of HIV Virologic Failure and Switch to Second-Line Therapy: A Systematic Review and Meta-analysis of Data From Sub-Saharan Africa

• Type of Material: Article
• Authors: Kerlly J Bernabe, Tulane University; Mark Siedner, Africa Health Research Institute, KwaZulu-Natal; Alexander C Tsai, Harvard Medical School; Vincent Marconi, Emory University; Richard A Murphy, Geisel School of Medicine at Dartmouth
• Language: English
• Date: 2022-05-01
• Publisher: OXFORD UNIV PRESS INC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/ofid/ofac121
• Title of Journal or Parent Work: OPEN FORUM INFECTIOUS DISEASES
• Volume: 9
• Issue: 5
• Start Page: ofac121
• End Page: ofac121
• Grant/Funding Information: This research was supported by the UCLA-Clinical and Translational Research Institute (UCLA-CTSI) at Lundquist/Harbor-UCLA and from the Emory Center for AIDS Research (P30 AI050409).
• Keywords: DELAYED SWITCH; CD4 COUNT; AIDS; resource-limited settings; CARE; Science & Technology; Microbiology; Infectious Diseases; VIRAL LOAD; Immunology; Life Sciences & Biomedicine; virologic failure; second-line antiretroviral therapy; TREATMENT OUTCOMES; MORTALITY; TIME; CLINICS; ANTIRETROVIRAL THERAPY; Sub-Saharan Africa; advanced HIV
• Research Categories: Health Sciences, Public Health

Abstract

Background: The late recognition of virologic failure (VF) places persons with HIV in Sub-Saharan Africa at risk for HIV transmission, disease progression, and death. We conducted a systematic review and meta-analysis to determine if the recognition and response to VF in the region has improved. Methods: We searched for studies reporting CD4 count at confirmed VF or at switch to second-line antiretroviral therapy (ART). Using a random-effects metaregression model, we analyzed temporal trends in CD4 count at VF-or at second-line ART switch-over time. We also explored temporal trends in delay between VF and switch to second-line ART. Results: We identified 26 studies enrolling patients with VF and 10 enrolling patients at second-line ART switch. For studies that enrolled patients at VF, pooled mean CD4 cell count at failure was 187 cells/mm3 (95% CI, 111 to 263). There was no significant change in CD4 count at confirmed failure over time (+4 cells/year; 95% CI,-7 to 15). Among studies that enrolled patients at second-line switch, the pooled mean CD4 count was 108 cells/mm3 (95% CI, 63 to 154). CD4 count at switch increased slightly over time (+10 CD4 cells/year; 95% CI, 2 to 19). During the same period, the mean delay between confirmation of VF and switch was 530 days, with no significant decline over time (-14 days/year; 95% CI,-58 to 52). Conclusions: VF in Africa remains an event recognized late in HIV infection, a problem compounded by ongoing delays between VF and second-line switch.