Showing 1 - 9 of 9 Results for "viral load"

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Additional efforts are needed in implementing viral load monitoring to increase adherence. A study found that viral load failure was identified a median of 10.4 months earlier through viral load testing as compared to CD4 testing. CD4 testing did not identify almost half of the patients in a large cohort experiencing treatment failure.
Adherence and Support
1 study
Promoting HIV testing for male and female adolescents prior to pregnancy or fatherhood may increase those on cART prior to pregnancy, thus decreasing viral load prior to pregnancy and increasing the likelihood of reduced risk of vertical transmission
Antenatal Care - Treatment
1 study
Increased detection of acute infection, along with immediate, effective counseling and support is needed. A trial is underway in Botswana to identify those with high viral loads to initiate treatment (Novitsky et al., 2010 cited in Delva and Abdool Karim, 2014).
Staying Healthy and Reducing Transmission
1 study
Well-functioning laboratory systems are needed to measure viral load via PCR to assess effectiveness of treatment. However, adequate clinical results can also be cost-effective and meet patient needs. A study in sub-Saharan Africa found that more than half of test results for viral load were invalid or inaccurate. A review done in low and middle-income countries showed that lack of routine virologic monitoring in resource limited ART programs led to the development of cross-resistance to the NRTI component of second-line treatment. Even where virological monitoring is available and demonstrates virological failure, delayed switching of patients to alternative antiretroviral therapy regimens occurs.
Provision and Access
1 study
Specific additional adherence support is needed for those who initiate ARVs at CD4 counts above 250. A review of forty randomized trials found that no consensus exists on how to effectively increase adherence, particularly among those living with HIV with no symptoms. A study found that initiating ARVs at CD4 above 250 was associated with increased odds and number of treatment interruptions and increased odds of persistent increased viral load within the first three months of ARV initiation.
Adherence and Support
1 study
Interventions are needed to enhance counseling to successfully prepare patients for lifelong therapy. Studies have found that patients were not well prepared for life-long therapy; that adherence rates decreased over time and hospital costs increased for those who were less adherent. A study found that patients believed that ART killed other patients, not understanding that initiating ART at high viral loads and low CD4 counts reduces the likelihood of survival.
Adherence and Support
1 study
Women and men need accurate information on vertical transmission, treatment adherence strategies, the importance of their viral load and the low risk of vertical transmission if virally suppressed. Adherence has been challenging for women living with HIV postpartum, even for those initiating ART during pregnancy at CD4 counts under 350, with adequate adherence dropping from 75.7% during pregnancy to 53% postpartum globally (Nachega et al., 2012 cited in Coutsoudis et al., 2013). Knowledge of HIV and vertical transmission has shown to be correlated with increased initiation, adherence and retention for pregnant women living with HIV.
Antenatal Care - Treatment
1 study
Further efforts are needed to determine the optimal frequency of testing in order to minimize HIV transmission in a cost-effective way. In some settings, testing for acute infection is warranted which would require testing every three to six months. A study found that 12% of women and 10% of women who had reported testing HIV-negative were found to be seropositive one to two years later. Modeling studies have found that screening one time, annually, can be cost-effective and that yearly testing in a high incidence area found that potential high-risk transmission with high viral load could be reduced by yearly HIV testing.
HIV Testing and Counseling for Women
1 study
Successful strategies are needed to increase adherence to ART among adolescents and reduce loss to follow up. A study found that adolescents and young adults aged 15 to 24 living with HIV were more likely, following treatment initiation, to have higher viral loads, higher rates of virological failure and greater low to follow up from services. Another study found that adolescents (ages 9 to 19) had poorer virological outcomes compared to young adults (ages 20 to 28). A review found few estimates on viral suppression among ages 10 to 19 (All in End Adolescent AIDS, 2015c). A specialized HIV management program could not retain a substantial proportion of those who tested positive for HIV in care. A review of studies of adherence among adolescents and children in Lower and Middle Income countries found that most studies were cross-sectional with age data ranging from six months to 21, limiting the ability to define which strategies are key to increasing adherence among ages 10 to 19. Cognitive behavioral therapy can be further explored as a strategy to increase adherence in adolescent populations.
Increasing Access to Services
1 study