Viral load versus CD4? monitoring and 5-year outcomes of antiretroviral therapy in HIV-positive children in Southern Africa: a cohort-based modelling study.

ABSTRACT: OBJECTIVES:Many paediatric antiretroviral therapy (ART) programmes in Southern Africa rely on CD4? to monitor ART. We assessed the benefit of replacing CD4? by viral load monitoring. DESIGN:A mathematical modelling study. METHODS:A simulation model of HIV progression over 5 years in children on ART, parameterized by data from seven South African cohorts. We simulated treatment programmes with 6-monthly CD4? or 6- or 12-monthly viral load monitoring. We compared mortality, second-line ART use, immunological failure and time spent on failing ART. In further analyses, we varied the rate of virological failure, and assumed that the rate is higher with CD4? than with viral load monitoring. RESULTS:About 7% of children were predicted to die within 5 years, independent of the monitoring strategy. Compared with CD4? monitoring, 12-monthly viral load monitoring reduced the 5-year risk of immunological failure from 1.6 to 1.0% and the mean time spent on failing ART from 6.6 to 3.6 months; 1% of children with CD4? compared with 12% with viral load monitoring switched to second-line ART. Differences became larger when assuming higher rates of virological failure. When assuming higher virological failure rates with CD4? than with viral load monitoring, up to 4.2% of children with CD4? compared with 1.5% with viral load monitoring experienced immunological failure; the mean time spent on failing ART was 27.3 months with CD4? monitoring and 6.0 months with viral load monitoring. Conclusion: Viral load monitoring did not affect 5-year mortality, but reduced time on failing ART, improved immunological response and increased switching to second-line ART.

SUBMITTER: Salazar-Vizcaya L 

PROVIDER: S-EPMC4231439 | biostudies-literature | 2014 Oct

REPOSITORIES: biostudies-literature