Table 2.
Comparison of effects of strategy of defining first-line failure of efavirenz-based regimens by a single viral load more than 1000 with strategy of two consecutive viral load more than 1000 copies/mla.
| Strategy for defining first-line failure of efavirenz-based regimen | |||
| Two consecutive VL > 1000 copies/ml (median 90% range over setting scenarios) | Single VL > 1000 copies/ml (median 90% range over setting scenarios) | Difference [(* or percentage reduction) between policies (mean 95% CI; median 90% range) over setting scenarios] | |
| Among ART-experienced persons, percentage who have started second line | 10.4% (5.6–19.1%) | 15.2% (9.5–26.5%) | +5.1% (+5.0, +5.2%) +4.8% (+3.4–+7.8%) |
| Of people on ART who have first experienced VL > 1000 copies/ml 2 years ago, proportion on ART (first or second line) with VL < 1000 copies/ml | 51% (33–68%) | 59% (36–80%) | +8% (+7–+8%) +8% (−3–+19%) |
| Of people on first-line ART with initial VL > 1000 in past year rate of AIDS (per 100 person-years) | 4.7 (2.4–8.4) | 3.2 (1.6–5.8) | 30% (28, 32%)* 31% (+8, +49%)* |
| AIDS death rate in people with previous or current VL > 1000 while on ARTb,c | 3.1 (1.7–6.8) | 2.5 (1.3–6.0) | 18% (18, 18%)* 18% (6, 30%)* |
| % Of people with drug resistance to efavirenz who have been switched to second-line ART | 48% (33–59%) | 65% (51–74%) | 17% (17, 17%) 17% (14, 20%) |
| Among those on ART (first or second line), % with VL < 1000 copies/ml | 92% (85–95%) | 94% (89–96%) | +2.9% (+2.8, +3.0%) +2.6% (+1.5, +4.8%) |
| Of people switched to second line, proportion with drug resistance to at least 1 first-line drug | 99% (95–100%) | 82% (68–91%) | –17% (–18, –16%) –17% (−28, –8%) |
| Of people defined as failing efavirenz-based first-line ART, % with NNRTI drug resistance | 97% (75–100%) | 72% (50–86%) | –23% (–24, –22%) –23% (–36, –12%) |
| Of persons on first-line ART with previous VL > 1000 (at least 6 months after start of ART), percentage with VL < 1000 copies/ml | 55% (41–65%) | 64% (50–72%) | 9% (9, 9%) 9% (6, 12%) |
ART, antiretroviral therapy; CI, confidence interval; NNRTI, nonnucleoside reverse-transcriptase inhibitor; VL, viral load.
aMean over 2018.75–2021.75 for each setting scenario, then summarized as mean and median over setting scenarios.
bMore than 6 months after (re)starting, and excluding people already started second line before baseline in 2018.75.
cAs shown in Fig. 1.