Early viral load monitoring predicts virological failure among HIV-infected individuals on anti-retroviral therapy - A single centre experience

Abstract

Background: Global estimates for people living with Human immunodeficiency virus (HIV) at 2017 was between 31.1 to 43.9 million. In Malaysia, people living with HIV (PLHIV) was reported to be 75,040 and 41,430 (55.2%) are on Anti-Retroviral Therapy (ART). ART is an effective treatment in reduction of mortality and maintain quality of life in PLHIV. HIV viral load (VL) monitoring is recommended while on ART. The frequency of monitoring of VL is important and at the same time costly. In this study, we evaluate the predictive value of VL testing at one year of ART after initiation of first line ART to identify risks of future virological failure (VF). This would enable appropriate resource allocation depends on risk of VF. Methods and materials: This is a retrospective study analyse HIV-infected adult aged 18 years and ART naïve from 2007 to 2015. All cases were initiated on first-line ART and attended at least 1 clinical follow up and have 1 VL done at 12th month of treatment. Non-citizen and cases transferred care to other centres were excluded. Cases outcomes are categorized into favourable (i.e. remained on first line therapy at 5 year of follow up) and non-favourable (i.e. loss to follow-up (LFU), VF and death). Results: Overall 1525 cases had VL done at 12th month post ART. The majority (81.1%) were male, aged 17 to 77-year-old with median of 37.14-year-old. 71.3% had initial CD4 count below 250cells/uL. At 12th month post ART, 79.8% (n = 1217) had VL < 40 copies/mL, 11.3% (n = 172) had VL 40 to 500 copies/mL and 8.9% had VL more than 500 copies/mL. At 60th month, 76.7% (n = 1170) had favourable outcome and 23.3% (n = 355) had non-favourable outcome. Non-favourable outcomes include 186 (12.2%) VF, 109 (7.1%) LFU and 60 (3.9%) death. 12th month VL suppressed showed statistically significant in favourable outcome at 60 months follow up. Conclusion: Viral load measurement at 12th months post ART predicts future risk of virological failure. This would enable clinicians to use different monitoring strategies based on the viral load at 12th months, especially in resource limited settings.