Evidence map›Paper›PMID 33882962›Full record

ArticleAIDS research and therapy2021

Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis.

Anita Mesic, Alexander Spina, Htay Thet Mar, Phone Thit, Tom Decroo, Annick Lenglet, Moe Pyae Thandar, Thin Thin Thwe, Aung Aung Kyaw, Tobias Homan and 8 more

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In one paragraph

Article in AIDS research and therapy, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

24 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Anita Mesic *Public Health Department, Médecins Sans Frontières, Plantage Middenlaan 14, 1001DD, Amsterdam, The Netherlands. anitamesic@gmail.com.ORCID 0000-0002-7541-6380
Alexander Spina *Public Health Department, Médecins Sans Frontières, Plantage Middenlaan 14, 1001DD, Amsterdam, The Netherlands.
Htay Thet MarMédecins Sans Frontières, Thingangyun Township, No 5/59, Ayeyadanar Street, Thirigon Villa, Waizayandar Road, Yangon, Myanmar.
Phone ThitMédecins Sans Frontières, Thingangyun Township, No 5/59, Ayeyadanar Street, Thirigon Villa, Waizayandar Road, Yangon, Myanmar.
Tom DecrooInstitute of Tropical Medicine, Department of Clinical Sciences, Kronenburgstraat 43, 2000, Antwerpen, Belgium.
Annick LengletPublic Health Department, Médecins Sans Frontières, Plantage Middenlaan 14, 1001DD, Amsterdam, The Netherlands.
Moe Pyae ThandarMédecins Sans Frontières, Thingangyun Township, No 5/59, Ayeyadanar Street, Thirigon Villa, Waizayandar Road, Yangon, Myanmar.
Thin Thin ThweMédecins Sans Frontières, Thingangyun Township, No 5/59, Ayeyadanar Street, Thirigon Villa, Waizayandar Road, Yangon, Myanmar.
Aung Aung KyawMédecins Sans Frontières, Thingangyun Township, No 5/59, Ayeyadanar Street, Thirigon Villa, Waizayandar Road, Yangon, Myanmar.
Tobias HomanMédecins Sans Frontières, Thingangyun Township, No 5/59, Ayeyadanar Street, Thirigon Villa, Waizayandar Road, Yangon, Myanmar.
Mitchell SangmaMédecins Sans Frontières, Thingangyun Township, No 5/59, Ayeyadanar Street, Thirigon Villa, Waizayandar Road, Yangon, Myanmar.
Ronald KremerPublic Health Department, Médecins Sans Frontières, Plantage Middenlaan 14, 1001DD, Amsterdam, The Netherlands.
Jane GriegBurnet Institute, 85 Commercial Road, Melbourne, VIC, 300, Australia.
Erwan PiriouPublic Health Department, Médecins Sans Frontières, Plantage Middenlaan 14, 1001DD, Amsterdam, The Netherlands.
Koert RitmeijerPublic Health Department, Médecins Sans Frontières, Plantage Middenlaan 14, 1001DD, Amsterdam, The Netherlands.
Josefien Van OlmenInstitute of Tropical Medicine, Department of Clinical Sciences, Kronenburgstraat 43, 2000, Antwerpen, Belgium.
Lutgarde Lynen *Institute of Tropical Medicine, Department of Clinical Sciences, Kronenburgstraat 43, 2000, Antwerpen, Belgium.
Htun Nyunt Oo *Disease Control Office, National AIDS Programme, Naypyidaw, Myanmar.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundProgress toward the global target for 95% virological suppression among those on antiretroviral treatment (ART) is still suboptimal. We describe the viral load (VL) cascade, the incidence of virological failure and associated risk factors among people living with HIV receiving first-line ART in an HIV cohort in Myanmar treated by the Médecins Sans Frontières in collaboration with the Ministry of Health and Sports Myanmar.

methodsWe conducted a retrospective cohort study, including adult patients with at least one HIV viral load test result and having received of at least 6 months' standard first-line ART. The incidence rate of virological failure (HIV viral load ≥ 1000 copies/mL) was calculated. Multivariable Cox's regression was performed to identify risk factors for virological failure.

resultsWe included 25,260 patients with a median age of 33.1 years (interquartile range, IQR 28.0-39.1) and a median observation time of 5.4 years (IQR 3.7-7.9). Virological failure was documented in 3,579 (14.2%) participants, resulting in an overall incidence rate for failure of 2.5 per 100 person-years of follow-up. Among those who had a follow-up viral load result, 1,258 (57.1%) had confirmed virological failure, of which 836 (66.5%) were switched to second-line treatment. An increased hazard for failure was associated with age ≤ 19 years (adjusted hazard ratio, aHR 1.51; 95% confidence intervals, CI 1.20-1.89; p < 0.001), baseline tuberculosis (aHR 1.39; 95% CI 1.14-1.49; p < 0.001), a history of low-level viremia (aHR 1.60; 95% CI 1.42-1.81; p < 0.001), or a history of loss-to-follow-up (aHR 1.24; 95% CI 1.41-1.52; p = 0.041) and being on the same regimen (aHR 1.37; 95% CI 1.07-1.76; p < 0.001). Cumulative appointment delay was not significantly associated with failure after controlling for covariates.

conclusionsVL monitoring is an important tool to improve programme outcomes, however limited coverage of VL testing and acting on test results hampers its full potential. In our cohort children and adolescents, PLHIV with history of loss-to-follow-up or those with low-viremia are at the highest risk of virological failure and might require more frequent virological monitoring than is currently recommended.

Indexed as

Anti-HIV AgentsHIV InfectionsAdolescentAdultChildCohort StudiesHumansInfant, NewbornMyanmarRetrospective StudiesAnti-HIV AgentsFirst-line antiretroviral treatmentHIVLost-to-follow upLow viremiaMyanmarVirological failure

Identifiers

PMID33882962
PMCPMC8059266

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.