Determining virological suppression and resuppression by point-of-care viral load testing in a HIV care setting in sub-Saharan Africa

Abstract

Background: This prospective pilot study explored same-day point-of-care viral load testing in a setting in Ghana that has yet to implement virological monitoring of antiretroviral therapy (ART).

Methods: Consecutive patients accessing outpatient care while on ART underwent HIV-1 RNA quantification by Xpert. Those with viraemia at the first measurement (T0) received immediate adherence counselling and were reassessed 8 weeks later (T1). Predictors of virological status were determined by logistic regression analysis. Drug resistance-associated mutations (RAMs) were detected by Sanger sequencing.

Findings: At T0, participants had received treatment for a median of 8·9 years; 297/333 (89·2%) were on NNRTI-based ART. The viral load was ≥40 copies/mL in 164/333 (49·2%) patients and ≥1000 copies/mL in 71/333 (21·3%). In the latter group, 50/65 (76·9%) and 55/65 (84·6%) harboured NRTI and NNRTI RAMs, respectively, and 27/65 (41·5%) had ≥1 tenofovir RAM. Among 150/164 (91·5%) viraemic patients that reattended at T1, 32/150 (21·3%) showed resuppression <40 copies/mL, comprising 1/65 (1·5%) subjects with T0 viral load ≥1000 copies/mL and 31/85 (36·5%) subjects with lower levels. A T0 viral load ≥1000 copies/mL and detection of RAMs predicted ongoing T1 viraemia independently of self-reported adherence levels. Among participants with T0 viral load ≥1000 copies/mL, 23/65 (35·4%) showed resuppression <1000 copies/mL; the response was more likely among those with higher adherence levels and no RAMs.

Interpretation: Same-day point-of-care viral load testing was feasible and revealed poor virological control and suboptimal resuppression rates despite adherence counselling. Controlled studies should determine optimal triaging modalities for same-day versus deferred viral load testing.

Funding: University of Liverpool, South Tees Infectious Diseases Research Fund.

Keywords: Adherence; Drug resistance; HIV; Point-of-care; Resuppression; Virological monitoring.

Conflict of interest statement

Dr. Smith reports personal fees from Gilead Sciences and ViiV, outside the submitted work; Dr. Chadwick reports personal fees from Gilead, outside the submitted work; Dr. Geretti reports grants from BMS, Gilead, Janssen, and ViiV, and personal fees from Roche Pharma Research & Early Discovery, outside the submitted work. All other authors have nothing to disclose.

© 2019 Published by Elsevier Ltd.

Figures

Fig. 1

Patients’ flow.

Fig. 2

A) Prevalence of  ≥ 1 resistance-associated mutation (RAM) by drug class and according to the T0 viral load; B) Box and whiskers of the genotypic susceptibility score (GSS) according to the T0 viral load; for each viral load stratum, the box indicates the distribution of the score (median and IQR); the dotted line connects the median values of the score.