Long-term Virological Outcomes of First-Line Antiretroviral Therapy for HIV-1 in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis: A systematic review and meta-analysis

T. Sonia Boender, Kim C. E. Sigaloff, James H. McMahon, Sasisopin Kiertiburanakul, Michael R. Jordan, Jhoney Barcarolo, Nathan Ford, Tobias F. Rinke de Wit, Silvia Bertagnolio

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109 Citations (Scopus)


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. 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. 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. 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
Original languageEnglish
Pages (from-to)1453-1461
Number of pages9
JournalClinical Infectious Diseases
Issue number9
Publication statusPublished - 1 Nov 2015


  • HIV-1
  • antiretroviral therapy
  • low- and middle-income countries
  • virological monitoring

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