Castelnuovo B., Sempa J., Agnes K.N., Kamya M.R., Manabe Y.C.
Infectious Diseases Institute, Makerere University, Mulago Hospital Complex, P.O. Box 22418, Kampala, Uganda; Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda; Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
Castelnuovo, B., Infectious Diseases Institute, Makerere University, Mulago Hospital Complex, P.O. Box 22418, Kampala, Uganda; Sempa, J., Infectious Diseases Institute, Makerere University, Mulago Hospital Complex, P.O. Box 22418, Kampala, Uganda; Agnes, K.N., Infectious Diseases Institute, Makerere University, Mulago Hospital Complex, P.O. Box 22418, Kampala, Uganda; Kamya, M.R., Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda; Manabe, Y.C., Infectious Diseases Institute, Makerere University, Mulago Hospital Complex, P.O. Box 22418, Kampala, Uganda, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
Our objective was to evaluate outcomes in patients with sustained viral suppression compared to those with episodes of viremia. Methods. In a prospective cohort of patients started on ART in Uganda and followed for 48 months, patients were categorized according to viral load (VL): (1) sustained-suppression: (VL ≤1,000 copies/mL) (2) VL 1,001-10,000, or (3) VL >10,000. Results. Fifty-Three (11.2%) and 84 (17.8%) patients had a first episode of intermediate and high viremia, respectively. Patients with sustained suppression had better CD4+ T cell count increases over time compared to viremic patients (P <.001). The majority of patients with viremia achieved viral suppression when the measurement was repeated. Only 39.6% of patients with intermediate and 19.1% with high viremia eventually needed to be switched to second line (P =.008). Conclusions. The use of at least one repeat measurement rather than a single VL measurement could avert from 60% to 80% of unnecessary switches. © 2011 Barbara Castelnuovo et al.