title: Is There a Need for Viral Load Testing to Assess Treatment Failure in HIV-Infected Patients Who Are about to Change to Tenofovir-Based First-Line Antiretroviral Therapy? Programmatic Findings from Myanmar.
abstract: BACKGROUND
  WHO recommends that stavudine is phased out of antiretroviral therapy (ART) programmes and replaced with tenofovir (TDF) for first-line treatment. In this context, the Integrated HIV Care Program, Myanmar, evaluated patients for ART failure using HIV RNA viral load (VL) before making the change. We aimed to determine prevalence and determinants of ART failure in those on first-line treatment.
  
  
  METHODS
  Patients retained on stavudine-based or zidovudine-based ART for >12 months with no clinical/immunological evidence of failure were offered VL testing from August 2012. Plasma samples were tested using real time PCR. Those with detectable VL>250 copies/ml on the first test were provided with adherence counseling and three months later a second test was performed with >1000 copies/ml indicating ART failure. We calculated the prevalence of ART failure and adjusted relative risks (aRR) to identify associated factors using log binomial regression.
  
  
  RESULTS
  Of 4934 patients tested, 4324 (87%) had an undetectable VL at the first test while 610 patients had a VL>250 copies/ml. Of these, 502 had a second VL test, of whom 321 had undetectable VL and 181 had >1000 copies/ml signifying ART failure. There were 108 who failed to have the second test. Altogether, there were 94% with an undetectable VL, 4% with ART failure and 2% who did not follow the VL testing algorithm. Risk factors for ART failure were age 15-24 years (aRR 2.4, 95% CI: 1.5-3.8) compared to 25-44 years and previous ART in the private sector (aRR 1.6, 95% CI: 1.2-2.2) compared to the public sector.
  
  
  CONCLUSIONS
  This strategy of evaluating patients on first-line ART before changing to TDF was feasible and identified a small proportion with ART failure, and could be considered by HIV/AIDS programs in Myanmar and other countries.
authors: International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar.
authors: Nay
authors: N
authors: Thiha
authors: Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
authors: Palanivel
authors: P
authors: Chinnakali
authors: International Union Against Tuberculosis and Lung Disease, Paris, France.|London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: Anthony D
authors: AD
authors: Harries
authors: National AIDS program, Department of Health, Nay Pyi Taw, Myanmar.
authors: Myint
authors: M
authors: Shwe
authors: International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar.
authors: Thanumalaya Perumal
authors: TP
authors: Balathandan
authors: Burnett Institute, Yangon, Myanmar.
authors: Sai
authors: S
authors: Thein Than Tun
authors: Medécins sans Frontières, Doctors without borders-OCB, Mumbai, India.
authors: Mrinalini
authors: M
authors: Das
authors: National Health Laboratory, Department of Health, Yangon, Myanmar.
authors: Htay Htay
authors: HH
authors: Tin
authors: Public Health Laboratory, Department of Health, Mandalay, Myanmar.
authors: Yi
authors: Y
authors: Yi
authors: FondationMereiux, Lyon, France.
authors: François Xavier
authors: FX
authors: Babin
authors: National Health Laboratory, Department of Health, Yangon, Myanmar.
authors: Thi Thi
authors: TT
authors: Lwin
authors: Hopital Lariboisière Groupe Hospitalier Saint-Louis Lariboisière, Paris, France.
authors: Philippe Albert
authors: PA
authors: Clevenbergh
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006678:HIV / Q000187:drug effects* / Q000502:physiology*; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D002052:Myanmar / Q000453:epidemiology; D000068698:Tenofovir / Q000494:pharmacology* / Q000627:therapeutic use; D017211:Treatment Failure; D019562:Viral Load / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000068698:Tenofovir