Objective: Viral load monitoring has been proposed as a tool to reinforce adherence, but outcomes have never been systematically assessed.
Design: A meta-analysis was conducted to systematically analyze the research on viral load monitoring as a tool to reinforce adherence. Viremic resuppression is defined here as a decrease in viral load beneath a particular threshold following viral load levels that have been elevated despite antiretroviral treatment.
Methods: Six databases were searched for studies published up to November 2012, which reported the use of viral load monitoring as a tool to identify patients in need of adherence support. Three conference abstract sites were reviewed for studies reported in the last 2 years. Randomized and quasi-randomized trials and observational studies, were eligible. No language or geographical restrictions were applied.
Results: Six retrospective and 2 prospective observational studies reported data from 8 countries: South Africa, the United States, Thailand, Mali, Burkina Faso, Swaziland, India, and France. Five studies reported on viremic resuppression, with a pooled estimate of 70.5% (95% confidence interval: 56.6% to 84.4%) resuppressed. The remaining 3 studies all reported declines in mean viral load. Delayed onset of routine viral load monitoring was associated with the emergence of drug resistance.
Conclusions: The clear trend of resuppression, following viral load testing and adherence support, demonstrates the utility of viral load as a tool to identify patients in need of enhanced adherence support.
*Access Campaign, Médecins Sans Frontières, Geneva, Switzerland; and
†Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa.
Correspondence to: Kimberly Bonner, MPA, MSF Access Campaign, Médecins Sans Frontières, Rue de Lausanne 78, P.O Box 116, CH-1211 Geneva 21, Switzerland (e-mail: Kimberly.firstname.lastname@example.org).
K.B. and A.M. contributed equally to this manuscript.
The authors have no funding or conflicts of interest to disclose.
N.F. conceived and designed the review, conducted the meta-analysis, and provided critical feedback; A.M. acquired articles, conducted full text searches, data abstraction, and drafted the article; K.B. conducted title and abstract search and full text searches, data abstraction, and drafted the article; T.R. provided critical edits; and J.C. provided substantial design support and edits to the manuscript.
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Received February 28, 2013
Accepted June 01, 2013