Risk factors for poor virological outcome at 12 months in a workplace-based antiretroviral therapy programme in South Africa

A cohort study

Katherine L. Fielding, Salome Charalambous, Amy Stenson, Lindiwe F. Pemba, Des J. Martin, Robin Wood, Gavin J. Churchyard, Alison D. Grant

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Background: Reasons for the variation in reported treatment outcomes from antiretroviral therapy (ART) programmes in developing countries are not clearly defined. Methods: Among ART-naïve individuals in a workplace ART programme in South Africa we determined virological outcomes at 12 months, and risk factors for suboptimal virological outcome, defined as plasma HIV-1 viral load <= 400 copies/ml. Results: Among 1760 individuals starting ART before July 2004, 1172 were in follow-up at 12 months of whom 953 (81%) had a viral load measurement (median age 41 yrs, 96% male, median baseline CD4 count 156 × 106/ l). 71% (681/953) had viral load > 400 copies/ml at 12 months. In a multivariable analysis, independent predictors of suboptimal virological outcome at 12 months were 100,000 compared to = 1 log decrease in viral load. Conclusion: Virological response at six weeks after ART start was the strongest predictor of suboptimal virological outcome at 12 months, and may identify individuals who need interventions such as additional adherence support. Self reported adherence was less strongly associated but identified different patients compared with viral load at 6 weeks. Site of delivery had an important influence on virological outcomes; factors at the health system level which influence outcome need further investigation to guide development of effective ART programmes.

Original languageEnglish (US)
Article number93
JournalBMC Infectious Diseases
Volume8
DOIs
StatePublished - Jul 16 2008
Externally publishedYes

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South Africa
Workplace
Cohort Studies
Viral Load
Therapeutics
Developing Countries
Health Status
HIV-1

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Risk factors for poor virological outcome at 12 months in a workplace-based antiretroviral therapy programme in South Africa : A cohort study. / Fielding, Katherine L.; Charalambous, Salome; Stenson, Amy; Pemba, Lindiwe F.; Martin, Des J.; Wood, Robin; Churchyard, Gavin J.; Grant, Alison D.

In: BMC Infectious Diseases, Vol. 8, 93, 16.07.2008.

Research output: Contribution to journalArticle

Fielding, Katherine L. ; Charalambous, Salome ; Stenson, Amy ; Pemba, Lindiwe F. ; Martin, Des J. ; Wood, Robin ; Churchyard, Gavin J. ; Grant, Alison D. / Risk factors for poor virological outcome at 12 months in a workplace-based antiretroviral therapy programme in South Africa : A cohort study. In: BMC Infectious Diseases. 2008 ; Vol. 8.
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