Institute of Tropical Medicine Antwerp
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Development and validation of systems for rational use of viral load testing in adults receiving first-line ART in sub-Saharan Africa

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dc.contributor.author Menten, J.
dc.contributor.author Kiragga, A.
dc.contributor.author Lynen, L.
dc.contributor.author Robertson, G.
dc.contributor.author Castelnuovo, B.
dc.contributor.author Manabe, Y. C.
dc.contributor.author Reynolds, S. J.
dc.contributor.author Roberts, L.
dc.date.accessioned 2011-08-30T09:46:39Z
dc.date.available 2011-08-30T09:46:39Z
dc.date.issued 2011
dc.identifier.issn 0269-9370
dc.identifier.doi http://dx.doi.org/10.1097/QAD.0b013e328349a414
dc.identifier.other ITG-I2A
dc.identifier.other ITG-C4A
dc.identifier.other INTER
dc.identifier.other U-CTU
dc.identifier.other CLINIC
dc.identifier.other U-HIVCLI
dc.identifier.other JIF
dc.identifier.other DOI
dc.identifier.other Abstract
dc.identifier.other UPD37
dc.identifier.uri http://hdl.handle.net/10390/6654
dc.description.abstract BACKGROUND:: World Health Organization (WHO) immunological and clinical criteria for monitoring first-line antiretroviral treatment (ART) offer low accuracy for predicting viral failure. Targeting viral load assays to those at high risk has been recommended and a system to do this has been developed in Cambodia. Systems for use in Sub-Saharan African populations were evaluated. METHODS:: A new Ugandan based scoring system for targeting viral load assays was developed from data from the first 4 years of a Ugandan cohort (N = 559) receiving first-line ART. The accuracy of this, the Cambodian system and the WHO criteria to predict viral failure, through targeting viral load assays, were compared in a separate population of 496 Ugandans. RESULTS:: The new Ugandan scoring system included CD4 count, mean cell volume, adherence, and HIV associated clinical events as predictors of viral failure. In the validation population, the Ugandan system undertook viral load assays in 61 (12.3%) cases offering 20.5% sensitivity and 100% positive predictive value (PPV) to predict viral failure. The Cambodian system undertook viral load assays in 33 (6.7%) cases producing 23.1% sensitivity and 90.0% PPV. WHO criteria recommended viral load assays in 72 (14.5%) cases offering 30.8% sensitivity and 100% PPV. CONCLUSIONS:: Locally developed algorithms based on clinical and immunological criteria may offer little additional accuracy over WHO criteria for targeting viral load assays. Where possible, confirming viral load before switching therapy is recommended. Scoring systems are more flexible than WHO criteria in allowing ART providers to choose the proportion of the population that undergo targeted viral load testing. en
dc.language English en
dc.subject Viral diseases en
dc.subject HIV en
dc.subject HAART en
dc.subject Antiretrovirals en
dc.subject Evaluation en
dc.subject Monitoring en
dc.subject First-line drugs en
dc.subject Prediction en
dc.subject World Health Organization (WHO) en
dc.subject WHO en
dc.subject Recommendations en
dc.subject Scoring system en
dc.subject Accuracy en
dc.subject Viral load en
dc.subject CD4 lymphocyte count en
dc.subject Compliance en
dc.subject Clinical manifestations en
dc.subject Sensitivity en
dc.subject Predictive value en
dc.subject Algorithms en
dc.subject Uganda en
dc.subject Africa, East en
dc.title Development and validation of systems for rational use of viral load testing in adults receiving first-line ART in sub-Saharan Africa en
dc.type Article en
dc.citation.issue 13 en
dc.citation.jtitle AIDS en
dc.citation.volume 25 en
dc.citation.pages 1627-1635 en
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/21673555
dc.citation.jabbreviation AIDS en


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