Measures of site resourcing predict virologic suppression, immunologic response and HIV disease progression following highly active antiretroviral therapy (HAART) in the TREAT Asia HIV Observational Database (TAHOD)

R. Oyomopito, M. P. Lee, P. Phanuphak, P. L. Lim, R. Ditangco, J. Zhou, T. Sirisanthana, Y. M.A. Chen, S. Pujari, N. Kumarasamy, S. Sungkanuparph, C. K.C. Lee, A. Kamarulzaman, S. Oka, F. J. Zhang, C. V. Mean, T. Merati, G. Tau, J. Smith, P. C.K. Li

Research output: Contribution to journalArticle

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Abstract

Objectives: Surrogate markers of HIV disease progression are HIV RNA in plasma viral load (VL) and CD4 cell count (immune function). Despite improved international access to antiretrovirals, surrogate marker diagnostics are not routinely available in resource-limited settings. Therefore, the objective was to assess effects of economic and diagnostic resourcing on patient treatment outcomes. Methods: Analyses were based on 2333 patients initiating highly active antiretroviral therapy (HAART) from 2000 onwards. Sites were categorized by World Bank country income criteria (high/low) and annual frequency of VL (≥3, 1-2 or <1) or CD4 (≥3 or <3) testing. Endpoints were time to AIDS/death and change in CD4 cell count and VL suppression (<400 HIV-1 RNA copies/mL) at 12 months. Demographics, Centers for Disease Control and Prevention (CDC) classification, baseline VL/CD4 cell counts, hepatitis B/C coinfections and HAART regimen were covariates. Time to AIDS/death was analysed by proportional hazards models. CD4 and VL endpoints were analysed using linear and logistic regression, respectively. Results:Increased disease progression was associated with site-reported VL testing less than once per year [hazard ratio (HR)=1.4; P=0.032], severely symptomatic HIV infection (HR=1.4; P=0.003) and hepatitis C virus coinfection (HR=1.8; P=0.011). A total of 1120 patients (48.2%) had change in CD4 cell count data. Smaller increases were associated with older age (P<0.001) and 'Other' HIV source exposures, including injecting drug use and blood products (P=0.043). A total of 785 patients (33.7%) contributed to the VL suppression analyses. Patients from sites with VL testing less than once per year [odds ratio (OR)=0.30; P<0.001] and reporting 'Other' HIV exposures experienced reduced suppression (OR=0.28; P<0.001). Conclusion: Low measures of site resourcing were associated with less favourable patient outcomes, including a 35% increase in disease progression in patients from sites with VL testing less than once per year.

Original languageEnglish
Pages (from-to)519-529
Number of pages11
JournalHIV Medicine
Volume11
Issue number8
DOIs
Publication statusPublished - Sep 1 2010
Externally publishedYes

Fingerprint

Highly Active Antiretroviral Therapy
Viral Load
Disease Progression
HIV
Databases
CD4 Lymphocyte Count
Coinfection
Acquired Immunodeficiency Syndrome
Biomarkers
Odds Ratio
RNA
United Nations
Centers for Disease Control and Prevention (U.S.)
Hepatitis C
Hepatitis B
Proportional Hazards Models
Hepacivirus
HIV Infections
HIV-1
Linear Models

Keywords

  • Antiretroviral therapy
  • Asia
  • CD4 counts
  • Diagnostic monitoring
  • Viral load

ASJC Scopus subject areas

  • Health Policy
  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Measures of site resourcing predict virologic suppression, immunologic response and HIV disease progression following highly active antiretroviral therapy (HAART) in the TREAT Asia HIV Observational Database (TAHOD). / Oyomopito, R.; Lee, M. P.; Phanuphak, P.; Lim, P. L.; Ditangco, R.; Zhou, J.; Sirisanthana, T.; Chen, Y. M.A.; Pujari, S.; Kumarasamy, N.; Sungkanuparph, S.; Lee, C. K.C.; Kamarulzaman, A.; Oka, S.; Zhang, F. J.; Mean, C. V.; Merati, T.; Tau, G.; Smith, J.; Li, P. C.K.

In: HIV Medicine, Vol. 11, No. 8, 01.09.2010, p. 519-529.

Research output: Contribution to journalArticle

Oyomopito, R, Lee, MP, Phanuphak, P, Lim, PL, Ditangco, R, Zhou, J, Sirisanthana, T, Chen, YMA, Pujari, S, Kumarasamy, N, Sungkanuparph, S, Lee, CKC, Kamarulzaman, A, Oka, S, Zhang, FJ, Mean, CV, Merati, T, Tau, G, Smith, J & Li, PCK 2010, 'Measures of site resourcing predict virologic suppression, immunologic response and HIV disease progression following highly active antiretroviral therapy (HAART) in the TREAT Asia HIV Observational Database (TAHOD)', HIV Medicine, vol. 11, no. 8, pp. 519-529. https://doi.org/10.1111/j.1468-1293.2010.00822.x
Oyomopito, R. ; Lee, M. P. ; Phanuphak, P. ; Lim, P. L. ; Ditangco, R. ; Zhou, J. ; Sirisanthana, T. ; Chen, Y. M.A. ; Pujari, S. ; Kumarasamy, N. ; Sungkanuparph, S. ; Lee, C. K.C. ; Kamarulzaman, A. ; Oka, S. ; Zhang, F. J. ; Mean, C. V. ; Merati, T. ; Tau, G. ; Smith, J. ; Li, P. C.K. / Measures of site resourcing predict virologic suppression, immunologic response and HIV disease progression following highly active antiretroviral therapy (HAART) in the TREAT Asia HIV Observational Database (TAHOD). In: HIV Medicine. 2010 ; Vol. 11, No. 8. pp. 519-529.
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abstract = "Objectives: Surrogate markers of HIV disease progression are HIV RNA in plasma viral load (VL) and CD4 cell count (immune function). Despite improved international access to antiretrovirals, surrogate marker diagnostics are not routinely available in resource-limited settings. Therefore, the objective was to assess effects of economic and diagnostic resourcing on patient treatment outcomes. Methods: Analyses were based on 2333 patients initiating highly active antiretroviral therapy (HAART) from 2000 onwards. Sites were categorized by World Bank country income criteria (high/low) and annual frequency of VL (≥3, 1-2 or <1) or CD4 (≥3 or <3) testing. Endpoints were time to AIDS/death and change in CD4 cell count and VL suppression (<400 HIV-1 RNA copies/mL) at 12 months. Demographics, Centers for Disease Control and Prevention (CDC) classification, baseline VL/CD4 cell counts, hepatitis B/C coinfections and HAART regimen were covariates. Time to AIDS/death was analysed by proportional hazards models. CD4 and VL endpoints were analysed using linear and logistic regression, respectively. Results:Increased disease progression was associated with site-reported VL testing less than once per year [hazard ratio (HR)=1.4; P=0.032], severely symptomatic HIV infection (HR=1.4; P=0.003) and hepatitis C virus coinfection (HR=1.8; P=0.011). A total of 1120 patients (48.2{\%}) had change in CD4 cell count data. Smaller increases were associated with older age (P<0.001) and 'Other' HIV source exposures, including injecting drug use and blood products (P=0.043). A total of 785 patients (33.7{\%}) contributed to the VL suppression analyses. Patients from sites with VL testing less than once per year [odds ratio (OR)=0.30; P<0.001] and reporting 'Other' HIV exposures experienced reduced suppression (OR=0.28; P<0.001). Conclusion: Low measures of site resourcing were associated with less favourable patient outcomes, including a 35{\%} increase in disease progression in patients from sites with VL testing less than once per year.",
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T1 - Measures of site resourcing predict virologic suppression, immunologic response and HIV disease progression following highly active antiretroviral therapy (HAART) in the TREAT Asia HIV Observational Database (TAHOD)

AU - Oyomopito, R.

AU - Lee, M. P.

AU - Phanuphak, P.

AU - Lim, P. L.

AU - Ditangco, R.

AU - Zhou, J.

AU - Sirisanthana, T.

AU - Chen, Y. M.A.

AU - Pujari, S.

AU - Kumarasamy, N.

AU - Sungkanuparph, S.

AU - Lee, C. K.C.

AU - Kamarulzaman, A.

AU - Oka, S.

AU - Zhang, F. J.

AU - Mean, C. V.

AU - Merati, T.

AU - Tau, G.

AU - Smith, J.

AU - Li, P. C.K.

PY - 2010/9/1

Y1 - 2010/9/1

N2 - Objectives: Surrogate markers of HIV disease progression are HIV RNA in plasma viral load (VL) and CD4 cell count (immune function). Despite improved international access to antiretrovirals, surrogate marker diagnostics are not routinely available in resource-limited settings. Therefore, the objective was to assess effects of economic and diagnostic resourcing on patient treatment outcomes. Methods: Analyses were based on 2333 patients initiating highly active antiretroviral therapy (HAART) from 2000 onwards. Sites were categorized by World Bank country income criteria (high/low) and annual frequency of VL (≥3, 1-2 or <1) or CD4 (≥3 or <3) testing. Endpoints were time to AIDS/death and change in CD4 cell count and VL suppression (<400 HIV-1 RNA copies/mL) at 12 months. Demographics, Centers for Disease Control and Prevention (CDC) classification, baseline VL/CD4 cell counts, hepatitis B/C coinfections and HAART regimen were covariates. Time to AIDS/death was analysed by proportional hazards models. CD4 and VL endpoints were analysed using linear and logistic regression, respectively. Results:Increased disease progression was associated with site-reported VL testing less than once per year [hazard ratio (HR)=1.4; P=0.032], severely symptomatic HIV infection (HR=1.4; P=0.003) and hepatitis C virus coinfection (HR=1.8; P=0.011). A total of 1120 patients (48.2%) had change in CD4 cell count data. Smaller increases were associated with older age (P<0.001) and 'Other' HIV source exposures, including injecting drug use and blood products (P=0.043). A total of 785 patients (33.7%) contributed to the VL suppression analyses. Patients from sites with VL testing less than once per year [odds ratio (OR)=0.30; P<0.001] and reporting 'Other' HIV exposures experienced reduced suppression (OR=0.28; P<0.001). Conclusion: Low measures of site resourcing were associated with less favourable patient outcomes, including a 35% increase in disease progression in patients from sites with VL testing less than once per year.

AB - Objectives: Surrogate markers of HIV disease progression are HIV RNA in plasma viral load (VL) and CD4 cell count (immune function). Despite improved international access to antiretrovirals, surrogate marker diagnostics are not routinely available in resource-limited settings. Therefore, the objective was to assess effects of economic and diagnostic resourcing on patient treatment outcomes. Methods: Analyses were based on 2333 patients initiating highly active antiretroviral therapy (HAART) from 2000 onwards. Sites were categorized by World Bank country income criteria (high/low) and annual frequency of VL (≥3, 1-2 or <1) or CD4 (≥3 or <3) testing. Endpoints were time to AIDS/death and change in CD4 cell count and VL suppression (<400 HIV-1 RNA copies/mL) at 12 months. Demographics, Centers for Disease Control and Prevention (CDC) classification, baseline VL/CD4 cell counts, hepatitis B/C coinfections and HAART regimen were covariates. Time to AIDS/death was analysed by proportional hazards models. CD4 and VL endpoints were analysed using linear and logistic regression, respectively. Results:Increased disease progression was associated with site-reported VL testing less than once per year [hazard ratio (HR)=1.4; P=0.032], severely symptomatic HIV infection (HR=1.4; P=0.003) and hepatitis C virus coinfection (HR=1.8; P=0.011). A total of 1120 patients (48.2%) had change in CD4 cell count data. Smaller increases were associated with older age (P<0.001) and 'Other' HIV source exposures, including injecting drug use and blood products (P=0.043). A total of 785 patients (33.7%) contributed to the VL suppression analyses. Patients from sites with VL testing less than once per year [odds ratio (OR)=0.30; P<0.001] and reporting 'Other' HIV exposures experienced reduced suppression (OR=0.28; P<0.001). Conclusion: Low measures of site resourcing were associated with less favourable patient outcomes, including a 35% increase in disease progression in patients from sites with VL testing less than once per year.

KW - Antiretroviral therapy

KW - Asia

KW - CD4 counts

KW - Diagnostic monitoring

KW - Viral load

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