Evidence map›Paper›PMID 34856180›Full record

ArticleThe lancet. HIV2021

Global estimates of viral suppression in children and adolescents and adults on antiretroviral therapy adjusted for missing viral load measurements: a multiregional, retrospective cohort study in 31 countries.

Win Min Han, Matthew G Law, Matthias Egger, Kara Wools-Kaloustian, Richard Moore, Catherine McGowan, Nagalingesawaran Kumarasamy, Sophie Desmonde, Andrew Edmonds, Mary-Ann Davies and 18 more

Abstract read
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In one paragraph

Article in The lancet. HIV, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 78 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
78citing papers in PubMed, 7 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

78 citing papers in PubMed, 7 syntheses or guidelines pooled it.

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  18. Correlates of Viral Suppression in Adolescents With HIV Taking Antiretroviral Therapy in Mozambique: Results of a Multicenter Cross-Sectional Survey.The Journal of adolescent health : official publication of the Society for Adolescent Medicine · 2026
    Article
  19. Article
  20. Barriers to Antiretroviral Therapy Adherence Among Children in Ekurhuleni, South Africa: A Descriptive Study.International journal of environmental research and public health · 2026
    Article

18 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

28 authors.

Win Min HanThe Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand. Electronic address: wmhan@kirby.unsw.edu.au.
Matthew G LawThe Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
Matthias EggerInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Kara Wools-KaloustianDepartment of Medicine, Indiana University, Indianapolis, IN, USA.
Richard MooreSchool of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Catherine McGowanDivision of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.
Nagalingesawaran KumarasamyChennai Antiviral Research and Treatment Clinical Research Site, The Voluntary Health Services, Chennai, India.
Sophie DesmondeINSERM U1027, Toulouse III University, Toulouse, France.
Andrew EdmondsDepartment of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Mary-Ann DaviesCenter for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Constantin YiannoutsosRM Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.
Keri N AlthoffBloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Claudia P CortesFundación Arriaran-Facultad de Medicina Universidad de Chile, Santiago, Chile.
Thahira Jamal MohamedPediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
Antoine JaquetUniversity of Bordeaux, Inserm, French National Research Institute for Sustainable Development, UMR 1219, Bordeaux, France.
Kathryn AnastosDepartment of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
Jonathan EuvrardCenter for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Barbara CastelnuovoInfectious Diseases Institute, Makerere University, Kampala, Uganda.
Kate SaltersBritish Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada.
Lara Esteves CoelhoInstituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Didier K EkoueviProgram PAC-CI, Abidjan, Côte d'Ivoire; Bordeaux Population Health (UMR1219), Bordeaux, France.
Brian EleyRed Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
Lameck DieroDepartment of Medicine, Moi University School of Medicine and Moi Teaching and Referral Hospital, Eldoret, Kenya.
Elizabeth ZaniewskiInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Nathan FordCenter for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; HIV/AIDS Department and Global Hepatitis Program, WHO, Geneva, Switzerland.
Annette H SohnTREAT Asia/amfAR, The Foundation for AIDS Research, Bangkok, Thailand.
Azar KariminiaThe Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
IeDEA collaboration

Funding

WOMEN'S HEALTH AGENDAU01AI038858 · NIAID · SOCIAL AND SCIENTIFIC SYSTEMS, INC. · PI BENSON, CONSTANCE ANN · 1996 to 2008
$157.5M
AIDS Clinical Trials Group NetworkU01AI068636 · NIAID · SOCIAL AND SCIENTIFIC SYSTEMS, INC. · PI KURITZKES, DANIEL R. · 2006 to 2010
$147.1M
UCSF CLINICAL AND TRANSLATIONAL SCIENCE INSTITUTEUL1RR024131 · NCRR · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI JOHNSTON, S. CLAIBORNE · 2006 to 2011
$111.2M
University of Washington/Fred Hutch Center for AIDS ResearchP30AI027757 · NIAID · UNIVERSITY OF WASHINGTON · PI CONNIE L CELUM · 1988 to 2026
$104.9M
Unsolicited R24 for the CFAR-Network of Integrated Clinical Sciences, CNICSR24AI067039 · NIAID · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI Michael S. Saag · 2006 to 2026
$99.4M
Virology CoreP30AI027763 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI STEVEN Grant DEEKS · 1988 to 2026
$93.6M
Virology CoreP30AI027767 · NIAID · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI OLAF KUTSCH · 1988 to 2026
$84.1M
STATISTICAL AND DATA MANAGEMENT CENTERU01AI038855 · NIAID · HARVARD UNIVERSITY (SCH OF PUBLIC HLTH) · PI HUGHES, MICHAEL DAVID · 1996 to 2006
$78.1M
Engaging University of California Stakeholders for Biorespository ResearchUL1TR000004 · NCATS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI GRANDIS, JENNIFER RUBIN · 2012 to 2015
$78.0M
Studies of Ocular Complications of AIDS - Coordinating CenterU10EY008057 · NEI · JOHNS HOPKINS UNIVERSITY · PI VAN NATTA, MARK L · 1988 to 2012
$78.0M
Virology, Immunology, and Microbiology CoreP30AI050410 · NIAID · UNIV OF NORTH CAROLINA CHAPEL HILL · PI DAVID M. MARGOLIS · 2001 to 2026
$76.9M
NATURAL HISTORY OF AIDS IN HOMOSEXUAL MENU01AI035040 · NIAID · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI DETELS, ROGER, MARTINEZ-MAZA, OTONIEL · 1993 to 2018
$75.2M
Intramural NIH HHS Z01 CP010176NCATS NIH HHS KL2 TR000421NCATS NIH HHS UL1 TR000004NCATS NIH HHS UL1 TR000083NCATS NIH HHS UL1 TR000454NCATS NIH HHS UL1 TR003098NCI NIH HHS N02 CP055504NCI NIH HHS R01 CA165937NCRR NIH HHS M01 RR000052NCRR NIH HHS UL1 RR024131NEI NIH HHS K23 EY013707NEI NIH HHS U10 EY008052NEI NIH HHS U10 EY008057NEI NIH HHS U10 EY008067NHLBI NIH HHS U01 HL146202NHLBI NIH HHS U01 HL146205NIAAA NIH HHS P01 AA029545NIAAA NIH HHS R01 AA016893NIAAA NIH HHS U01 AA013566NIAAA NIH HHS U01 AA020790NIAAA NIH HHS U24 AA020794NIAID NIH HHS K01 AI093197NIAID NIH HHS K24 AI065298NIAID NIH HHS P30 AI027757NIAID NIH HHS P30 AI027763NIAID NIH HHS P30 AI027767NIAID NIH HHS P30 AI036219NIAID NIH HHS P30 AI050410NIAID NIH HHS P30 AI094189NIAID NIH HHS P30 AI110527NIAID NIH HHS R24 AI067039NIAID NIH HHS R24 AI124872NIAID NIH HHS U01 AI031834NIAID NIH HHS U01 AI034989NIAID NIH HHS U01 AI034993NIAID NIH HHS U01 AI034994NIAID NIH HHS U01 AI035004NIAID NIH HHS U01 AI035039NIAID NIH HHS U01 AI035040NIAID NIH HHS U01 AI035041NIAID NIH HHS U01 AI035042NIAID NIH HHS U01 AI037613NIAID NIH HHS U01 AI037984NIAID NIH HHS U01 AI038855NIAID NIH HHS U01 AI038858NIAID NIH HHS U01 AI042590NIAID NIH HHS U01 AI068634NIAID NIH HHS U01 AI068636NIAID NIH HHS U01 AI069432NIAID NIH HHS U01 AI069434NIAID NIH HHS U01 AI069907NIAID NIH HHS U01 AI069911NIAID NIH HHS U01 AI069918NIAID NIH HHS U01 AI069919NIAID NIH HHS U01 AI069923NIAID NIH HHS U01 AI069924NIAID NIH HHS U01 AI096299NIAID NIH HHS U01 AI103390NIAID NIH HHS U01 AI103397NIAID NIH HHS U01 AI103401NIAID NIH HHS U01 AI103408NIAID NIH HHS UM1 AI035043NIAID NIH HHS UM1 AI069432NIA NIH HHS R21 AG059505NIA NIH HHS U54 AG062334NICHD NIH HHS U01 HD032632NIDA NIH HHS F31 DA037788NIDA NIH HHS K24 DA000432NIDA NIH HHS R01 DA004334NIDA NIH HHS R01 DA011602NIDA NIH HHS R01 DA012568NIDA NIH HHS T32 DA037801NIDA NIH HHS U01 DA036297NIDA NIH HHS U01 DA036935NIGMS NIH HHS U54 GM133807NIMHD NIH HHS G12 MD007583NIMHD NIH HHS U54 MD007587NIMH NIH HHS P30 MH062246World Health Organization 001
6 · The paper itself

Abstract

backgroundAs countries move towards the UNAIDS's 95-95-95 targets and with strong evidence that undetectable equals untransmittable, it is increasingly important to assess whether those with HIV who are receiving antiretroviral therapy (ART) achieve viral suppression. We estimated the proportions of children and adolescents and adults with viral suppression at 1, 2, and 3 years after initiating ART.

methodsIn this retrospective cohort study, seven regional cohorts from the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium contributed data from individuals initiating ART between Jan 1, 2010, and Dec 31, 2019, at 148 sites in 31 countries with annual viral load monitoring. Only people with HIV who started ART after the time a site started routine viral load monitoring were included. Data up to March 31, 2020, were analysed. We estimated the proportions of children and adolescents (aged <18 years at ART initiation) and adults (aged ≥18 years at ART initiation) with viral suppression (viral load <1000 copies per mL) at 1, 2, and 3 years after ART initiation using an intention-to-treat approach and an adjusted approach that accounted for missing viral load measurements.

findings21 594 children and adolescents (11 812 [55%] female, 9782 [45%] male) from 106 sites in 22 countries and 255 662 adults (163 831 [64%] female, 91 831 [36%] male) from 143 sites in 30 countries were included. Using the intention-to-treat approach, the proportion of children and adolescents with viral suppression was 7303 (36%) of 20 478 at 1 year, 5709 (30%) of 19 135 at 2 years, and 4287 (24%) of 17 589 at 3 years after ART initiation; the proportion of adults with viral suppression was 106 541 (44%) of 240 600 at 1 year, 79 141 (36%) of 220 925 at 2 years, and 57 970 (29%) of 201 124 at 3 years after ART initiation. After adjusting for missing viral load measurements among those who transferred, were lost to follow-up, or who were in follow-up without viral load testing, the proportion of children and adolescents with viral suppression was 12 048 (64% [plausible range 43-81]) of 18 835 at 1 year, 10 796 (62% [41-77]) of 17 553 at 2 years, and 9177 (59% [38-91]) of 15 667 at 3 years after ART initiation; the proportion of adults with viral suppression was 176 964 (79% [53-80]) of 225 418 at 1 year, 145 552 (72% [48-79]) of 201 238 at 2 years, and 115 260 (65% [43-69]) of 178 458 at 3 years after ART initiation.

interpretationAlthough adults with HIV are approaching the global target of 95% viral suppression, progress among children and adolescents is much slower. Substantial efforts are still needed to reach the viral suppression target for children and adolescents.

fundingUS National Institutes of Health.

Indexed as

Anti-HIV AgentsHIV InfectionsAdolescentAdultChildFemaleHumansMaleRetrospective StudiesSerologic TestsViral LoadAnti-HIV Agents

Identifiers

PMID34856180
PMCPMC8782625

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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.