title: Long-term Virological Outcomes of First-Line Antiretroviral Therapy for HIV-1 in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  More than 11.7 million people are currently receiving antiretroviral therapy (ART) in low- and middle-income countries (LMICs), and focused efforts are needed to ensure high levels of adherence and to minimize treatment failure. Recently, international targets have emphasized the importance of long-term virological suppression as a key measure of program performance.
  
  
  METHODS
  We systematically reviewed publications and conference abstracts published between January 2006 and May 2013 that reported virological outcomes among human immunodeficiency virus type 1 (HIV-1)-infected adults receiving first-line ART for up to 5 years in LMICs. Summary estimates of virological suppression after 6, 12, 24, 36, 48, and 60 months of ART were analyzed using random-effects meta-analysis. Intention-to-treat (ITT) analysis assumed all participants who were lost to follow-up, died, or stopped ART as having virological failure.
  
  
  RESULTS
  Summary estimates of virological suppression remained >80% for up to 60 months of ART for all 184 included cohorts. ITT analysis yielded 74.7% (95% confidence interval [CI], 72.2-77.2) suppression after 6 months and 61.8% (95% CI, 44.0-79.7) suppression after 48 months on ART. Switches to second-line ART were reported scarcely.
  
  
  CONCLUSIONS
  Among individuals retained on ART, virological suppression rates during the first 5 years of ART were high (>80%) and stable. Suppression rates in ITT analysis declined during 4 years.
authors.affiliation: Amsterdam Institute for Global Health and Development and Department of Global Health, Academic Medical Center of the University of Amsterdam.
authors.forename: T Sonia
authors.initials: TS
authors.lastname: Boender
authors.affiliation: Amsterdam Institute for Global Health and Development and Department of Global Health, Academic Medical Center of the University of Amsterdam Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Kim C E
authors.initials: KC
authors.lastname: Sigaloff
authors.affiliation: Department of Infectious Diseases, Alfred Hospital, Melbourne, Australia Tufts University School of Medicine and Tufts Medical Center, Boston, Massachusetts.
authors.forename: James H
authors.initials: JH
authors.lastname: McMahon
authors.affiliation: Division of Infectious Diseases, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand.
authors.forename: Sasisopin
authors.initials: S
authors.lastname: Kiertiburanakul
authors.affiliation: Tufts University School of Medicine and Tufts Medical Center, Boston, Massachusetts.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jordan
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Jhoney
authors.initials: J
authors.lastname: Barcarolo
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.affiliation: Amsterdam Institute for Global Health and Development and Department of Global Health, Academic Medical Center of the University of Amsterdam.
authors.forename: Tobias F
authors.initials: TF
authors.lastname: Rinke de Wit
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bertagnolio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV-1; antiretroviral therapy; low- and middle-income countries; virological monitoring