|
Title
|
|
|
|
An algorithm to optimize viral load testing in HIV-positive patients with suspected first-line antiretroviral therapy failure in Cambodia
| |
|
Author
|
|
|
|
| |
|
Abstract
|
|
|
|
| Objective: To develop an algorithm for optimal use of viral load testing in patients with suspected first-line antiretroviral treatment (ART) failure. Methods: Data from a cohort of patients on first-line ART in Cambodia were analyzed in a cross-sectional way to detect markers for treatment failure. Markers with an adjusted likelihood ratio <0.67 or >1.5 were retained to calculate a predictor score. The accuracy of a 2-step algorithm based on this score followed by targeted viral load testing was compared with World Health Organization criteria for suspected treatment failure. Results: One thousand eight hundred three viral load measurements of 764 patients were available for analysis. Prior ART exposure, CD4 count below baseline, 25% and 50% drop from peak CD4 count, hemoglobin drop of ¡Ý1 g/dL, CD4 count <100 cells per microliter after 12 months of treatment, new onset of papular pruritic eruption, and visual analog scale <95% were included in the predictor score. A score ¡Ý2 had the best combination of sensitivity and specificity and required confirmatory viral load testing for only 9% of patients. World Health Organization criteria had a similar sensitivity but a lower specificity and required viral load testing for 24.9% of patients. Conclusion: An algorithm combining a predictor score with targeted viral load testing in patients with an intermediate probability of failure optimizes the use of scarce resources. |
| |
|
Language
|
|
|
|
English
| |
|
Source (journal)
|
|
|
|
JAIDS. - Philadelphia, Pa
| |
|
Publication
|
|
|
|
Philadelphia, Pa
:
2009
| |
|
ISSN
|
|
|
|
1525-4135
| |
|
DOI
|
|
|
|
10.1097/QAI.0B013E3181AF6705
| |
|
Volume/pages
|
|
|
|
52
:1
(2009)
, p. 40-48
| |
|
ISI
|
|
|
|
000269373400006
| |
|
Full text (Publisher's DOI)
|
|
|
|
| |
|