TY - JOUR
T1 - Development and evaluation of a clinical algorithm to monitor patients on antiretrovirals in resource-limited settings using adherence, clinical and CD4 cell count criteria
AU - Meya, David
AU - Spacek, Lisa A.
AU - Tibenderana, Hilda
AU - John, Laurence
AU - Namugga, Irene
AU - Magero, Stephen
AU - Dewar, Robin
AU - Quinn, Thomas C.
AU - Colebunders, Robert
AU - Kambugu, Andrew
AU - Reynolds, Steven J.
N1 - Funding Information:
Informed consent was obtained from all the participants. Ethical approval for this study was obtained from the National Council of Science and Technology (Uganda) and from the National Institute of Allergy & Infectious Diseases (USA).
Funding Information:
We would like to thank Florence Aber, Bret Hendel-Paterson, Susan Hopkins, Richard D Moore, Sundhiya Mandalia, Jessica Oyugi, Rose Naluggya, Ali Taylor, Petra Schaefer, David Thomas, Keith McAdam and all the staff of the Adult Infectious Disease Clinic and the Academic Alliance. The study was funded by the Division of Intramural Research of the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, USA. We also acknowledge support from the Career Development Award K23 AI060384 (LAS).
Funding Information:
The study was funded by the Division of Intramural Research of the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, USA. We also acknowledge support from the Career Development Award K23 AI060384 (LAS).
Publisher Copyright:
© 2009 Meya et al; licensee BioMed Central Ltd.
PY - 2009/2
Y1 - 2009/2
N2 - Background: Routine viral load monitoring of patients on antiretroviral therapy (ART) is not affordable in most resource-limited settings. Methods: A cross-sectional study of 496 Ugandans established on ART was performed at the Infectious Diseases Institute, Kampala, Uganda. Adherence, clinical and laboratory parameters were assessed for their relationship with viral failure by multivariate logistic regression. A clinical algorithm using targeted viral load testing was constructed to identify patients for second-line ART. This algorithm was compared with the World Health Organization (WHO) guidelines, which use clinical and immunological criteria to identify failure in the absence of viral load testing. Results: Forty-nine (10%) had a viral load of >400 copies/mL and 39 (8%) had a viral load of >1000 copies/mL. An algorithm combining adherence failure (interruption >2 days) and CD4 failure (30% fall from peak) had a sensitivity of 67% for a viral load of >1000 copies/mL, a specificity of 82%, and identified 22% of patients for viral load testing. Sensitivity of the WHO-based algorithm was 31%, specificity was 87%, and would result in 14% of those with viral suppression (<400 copies/mL) being switched inappropriately to second-line ART. Conclusion: Algorithms using adherence, clinical and CD4 criteria may better allocate viral load testing, reduce the number of patients continued on failing ART, and limit the development of resistance.
AB - Background: Routine viral load monitoring of patients on antiretroviral therapy (ART) is not affordable in most resource-limited settings. Methods: A cross-sectional study of 496 Ugandans established on ART was performed at the Infectious Diseases Institute, Kampala, Uganda. Adherence, clinical and laboratory parameters were assessed for their relationship with viral failure by multivariate logistic regression. A clinical algorithm using targeted viral load testing was constructed to identify patients for second-line ART. This algorithm was compared with the World Health Organization (WHO) guidelines, which use clinical and immunological criteria to identify failure in the absence of viral load testing. Results: Forty-nine (10%) had a viral load of >400 copies/mL and 39 (8%) had a viral load of >1000 copies/mL. An algorithm combining adherence failure (interruption >2 days) and CD4 failure (30% fall from peak) had a sensitivity of 67% for a viral load of >1000 copies/mL, a specificity of 82%, and identified 22% of patients for viral load testing. Sensitivity of the WHO-based algorithm was 31%, specificity was 87%, and would result in 14% of those with viral suppression (<400 copies/mL) being switched inappropriately to second-line ART. Conclusion: Algorithms using adherence, clinical and CD4 criteria may better allocate viral load testing, reduce the number of patients continued on failing ART, and limit the development of resistance.
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U2 - 10.1186/1758-2652-12-3
DO - 10.1186/1758-2652-12-3
M3 - Article
AN - SCOPUS:84856505874
SN - 1758-2652
VL - 12
JO - Journal of the International AIDS Society
JF - Journal of the International AIDS Society
IS - 1
M1 - 3
ER -