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Low rates of virologic failure among previously unmonitored patients in Malawi

Session: Poster Abstract Session: HIV Treatment: Outcomes, Adherence, and Toxicities
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Virologic monitoring for HIV-infected ART patients is largely unavailable in resource-limited settings. Undetected viremia may contribute to transmission and breed resistance. Treatment failure may be more common among patients who are not monitored for extended periods. We explored the prevalence of ART failure among previously unmonitored ART patients in Malawi. 

Methods: Participants were enrolled from 5 hospitals and were eligible if they were ≥18 and had been on ART for 6 or 24 months or any 2-year period thereafter or if provider suspected failure. Virologic testing was done on dried blood spot cards using Abbott Real-Time HIV-1 Assay. Summary statistics were compared using independent group t-tests (continuous variables) and Pearson's χ2 tests (categorical variables). We used logistic regression to investigate the association between ART history, patient demographics, and virologic failure (viral load >5,000 cp/ml). 

Results: Of 1,479 participants, 30% were male with an average age of 42 [SD: 10.2]. 64% were on ART ≤4 years (9% 6 months; 32% 2 years; 23% 4 years) and 22.9% had signs of clinical failure. 870 (68%) were classified as WHO stage 3/4 at ART initiation. Only 79 (5.3%) met virologic failure criteria. Proportion male (27.9% vs 29.9%, p=0.70), on ART>4 years (40.6% vs 31.7%, p=0.12), with signs of clinical failure (26.9% vs 22.7%, p=0.39), or WHO stage 3 or 4 at initiation (64.7% vs 68.4%, p=0.52) did not differ between patients with virologic failure and those not failing. Failing participants were younger (37.8 vs 42.5, p<0.01).  Holding sex, time on ART, clinical symptoms, and initiation WHO stage constant, increasing age was associated with decreased odds of treatment failure (OR:0.96, CI[0.93, 0.99]). Being on ART>4 years was associated with increased odds of failure (OR: 2.25, CI[1.27, 3.98]).

Conclusion: We observed an unexpectedly low prevalence of virologic failure among previously unmonitored patients. After controlling for factors that could contribute to treatment failure, younger patients and patients on ART >4 years were more likely to be failing. These results may suggest deficiency in adolescent adherence and adult ART care transitions. Despite being retained in care, our findings demonstrate the importance of virologic monitoring among patients on ART for extended periods, regardless of clinical symptoms.

Sarah E. Rutstein1, Mina Hosseinipour, MD, MPH2, Alice Soko2, Memory Mkandawire3, Eva Stein2, Charles Mclendon2, Deborah Kamwendo2, Mary Kadiwa2, Eldee Paladar3, Abdoulaye Sarr4, Sundeep Gupta, MD, MPH5, Frank Chimbwandira6, Reuben Mwenda6 and Ronald Mataya, MD7, (1)Department of Health Policy and Management, UNC Chapel Hill, Chapel Hill, NC, (2)UNC Project, University of North Carolina, Lilongwe, Malawi, (3)Laboratory Capacity Consortium, Lilongwe, Malawi, (4)CDC - Malawi, Lilongwe, Malawi, (5)Centers for Disease Control and Prevention, Atlanta, GA, (6)Malawi Ministry of Health, Lilongwe, Malawi, (7)School of Public Health, Loma Linda University, Loma Linda, CA


S. E. Rutstein, None

M. Hosseinipour, None

A. Soko, None

M. Mkandawire, None

E. Stein, None

C. Mclendon, None

D. Kamwendo, None

M. Kadiwa, None

E. Paladar, None

A. Sarr, None

S. Gupta, None

F. Chimbwandira, None

R. Mwenda, None

R. Mataya, None

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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