Factors associated with virological suppression to antiretroviral therapy among people living with HIV

Abstract

Background: In Taiwan free access to highly active antiretroviral therapy (HAART) has been provided to people living with HIV since 1997 At the end of 2012 12 602 (61 7%) of 20 438 people living with HIV were treated with HAART in Taiwan Optimal virological suppression is the indicator for treatment outcome The study purpose is to determine the duration and the associated factors of virological suppression among people treated by HAART Methods: Eligible participants were initiating HAART for at least 6 months during 2008 to 2012 whom were followed up at a HIV-designated hospital in southern Taiwan Kaplan-Meier survival analysis and Cox proportional hazard model were used to estimate time and factors associated with virological suppression by HAART Results: A total of 250 patients were included in the study cohort with mean age of 33±10 (range 16-76) years 95% were male and 70% reported men having sex with men as a primary behaviors for HIV transmission Most of patients (90 8%) have enrolled in the hospital-based case management program The mean duration of HAART is 28±14 months (range 7-58 months) After 3 months of treatment initiation 56% had reached at least one event of undetectable viral load and 98% achieved virological suppression after 36 months Overall 81% (n=203) had successfully maintained a consistent viral suppression (median=102 weeks) after the first undetectable viral load In the Cox proportional hazard model an adherence of ?95% (adj HR 2 1 95% CI 1 359-3 247) and regular retention in care (adj HR 2 9 95% CI 1 24-7 13) were two facilitators to viral suppression But unemployment (adj HR 0 43 95% CI 0 21-0 85) and initial viral load level greater than 10 000 unit (adj HR 0 309 & 0 173) were barriers to viral suppression Conclusion: About 88% of patients had reached first viral suppression within 6 months of HAART Adherence to HAART represents the strongest factor associated with virological suppression Identification of patients with unemployment or have barriers to adhere medical regimen may ensure the delivery of the optimal benefit of HAART

Date of Award	2014 May 30
Original language	English
Supervisor	Nai-Ying Ko (Supervisor)