Salazar-Vizcaya L., Keiser O., Technau K., Davies M.-A., Haas A.D., Blaser N., Cox V., Eley B., Rabie H., Moultrie H., Giddy J., Wood R., Egger M., Estill J.
Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, Bern, Switzerland; Rahima Moosa Hospital, University of the Witwatersrand, Johannesburg, South Africa; School of Public Health and Family Medicine, University of Cape Town, South Africa; Khayelitsha ART Programme, Médecins Sans Frontières, India; Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa; Tygerberg Academic Hospital, University of Stellenbosch, Stellenbosch, South Africa; Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; McCord Hospital, Durban, South Africa; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
Salazar-Vizcaya, L., Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, Bern, Switzerland; Keiser, O., Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, Bern, Switzerland; Technau, K., Rahima Moosa Hospital, University of the Witwatersrand, Johannesburg, South Africa; Davies, M.-A., School of Public Health and Family Medicine, University of Cape Town, South Africa; Haas, A.D., Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, Bern, Switzerland; Blaser, N., Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, Bern, Switzerland; Cox, V., Khayelitsha ART Programme, Médecins Sans Frontières, India; Eley, B., Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa; Rabie, H., Tygerberg Academic Hospital, University of Stellenbosch, Stellenbosch, South Africa; Moultrie, H., Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Giddy, J., McCord Hospital, Durban, South Africa; Wood, R., Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa; Egger, M., Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, Bern, Switzerland, School of Public Health and Family Medicine, University of Cape Town, South Africa; Estill, J., Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, Bern, Switzerland
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. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.