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An algorithm to optimize viral load testing in HIV-positive patients with suspected first-line antiretroviral therapy failure in Cambodia

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dc.contributor.author Lynen, L.
dc.contributor.author An, S.
dc.contributor.author Koole, O.
dc.contributor.author Ros, S.
dc.contributor.author De Munter, P.
dc.contributor.author Sculier, D.
dc.contributor.author Arnould, L.
dc.contributor.author Fransen, K.
dc.contributor.author Menten, J.
dc.contributor.author Boelaert, M.
dc.contributor.author Van den Ende, J.
dc.contributor.author Colebunders, R.
dc.date.accessioned 2009-12-21T15:02:20Z
dc.date.available 2009-12-21T15:02:20Z
dc.date.issued 2009
dc.identifier.issn 1525-4135
dc.identifier.doi http://dx.doi.org/10.1097/QAI.0b013e3181af6705
dc.identifier.other ITG-C1A
dc.identifier.other ITG-C3B
dc.identifier.other ITG-C7B
dc.identifier.other ITG-C8B
dc.identifier.other ITG-M9A
dc.identifier.other ITG-I10A
dc.identifier.other ITG-H11A
dc.identifier.other ITG-C12A
dc.identifier.other ITG-CLA
dc.identifier.other MULTI-3
dc.identifier.other CLINIC
dc.identifier.other U-HIVCLI
dc.identifier.other U-TROPIC
dc.identifier.other MICRO
dc.identifier.other U-ARLAB
dc.identifier.other INTER
dc.identifier.other U-CTU
dc.identifier.other HEALTH
dc.identifier.other U-EPID
dc.identifier.other JIF
dc.identifier.other DOI
dc.identifier.other UPD17
dc.identifier.other ABSTRACT
dc.identifier.uri http://hdl.handle.net/10390/2868
dc.description.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 ≥1 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 ≥2 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. en
dc.language English en
dc.subject Viral diseases en
dc.subject HIV en
dc.subject AIDS en
dc.subject Antiretrovirals en
dc.subject First-line drugs en
dc.subject Drug resistance en
dc.subject Viral load en
dc.subject Monitoring en
dc.subject Efficiency en
dc.subject Algorithms en
dc.subject Accuracy en
dc.subject Sensitivity en
dc.subject Specificity en
dc.subject Predictive value en
dc.subject Cambodia en
dc.subject Asia, Southeast en
dc.title An algorithm to optimize viral load testing in HIV-positive patients with suspected first-line antiretroviral therapy failure in Cambodia en
dc.type Article en
dc.citation.issue 1 en
dc.citation.jtitle Journal of Acquired Immune Deficiency Syndromes en
dc.citation.volume 52 en
dc.citation.pages 40-48 en
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/19550349
dc.citation.jabbreviation J Acquire Immune Defic Syndr en


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