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A clinical prediction score in addition to WHO criteria for anti-retroviral treatment failure in resource-limited settings - experience from Lesotho

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Show simple item record Labhardt, N. D. Lejone, T. Setoko, M. Poka, M. Ehmer, J. Pfeiffer, K. Kiuvu, P. Z. Lynen, L. 2012-12-14T15:30:15Z 2012-12-14T15:30:15Z 2012
dc.identifier.issn 1932-6203
dc.identifier.other ITG-CLA
dc.identifier.other DCS
dc.identifier.other U-INFDIS
dc.identifier.other U-CTU
dc.identifier.other JIF
dc.identifier.other DOI
dc.identifier.other FTA
dc.identifier.other Abstract
dc.identifier.other UPD53
dc.description.abstract OBJECTIVE: To assess the positive predictive value (PPV) of a clinical score for viral failure among patients fulfilling the WHO-criteria for anti-retroviral treatment (ART) failure in rural Lesotho. METHODS: Patients fulfilling clinical and/or immunological WHO failure-criteria were enrolled. The score includes the following predictors: Prior ART exposure (1 point), CD4-count below baseline (1), 25% and 50% drop from peak CD4-count (1 and 2), hemoglobin drop>/=1 g/dL (1), CD4 count<100/microl after 12 months (1), new onset papular pruritic eruption (1), and adherence<95% (3). A nurse assessed the score the day blood was drawn for viral load (VL). Reported confidence intervals (CI) were calculated using Wilsons method. RESULTS: Among 1'131 patients on ART>/=6 months, 134 (11.8%) had immunological and/or clinical failure, 104 (78%) had blood drawn (13 died, 10 lost to follow-up, 7 did not show up). From 92 (88%) a result could be obtained (2 samples hemolysed, 10 lost). Out of these 92 patients 47 (51%) had viral failure (>/=5000 copies), 27 (29%) viral suppression (<40) and 18 (20%) intermediate viremia (40-4999). Overall, 20 (22%) had a score>/=5. A score>/=5 had a PPV of 100% to detect a VL>40 copies (95%CI: 84-100), and of 90% to detect a VL>/=5000 copies (70-97). Within the score, adherence<95%, CD4-count<100/microl and papular pruritic eruption were the strongest single predictors. Among 47 patients failing, 8 (17%) died before or within 4 weeks after being switched. Overall mortality was 4 (20%) among those with score>/=5 and 4 (5%) if score<5 (OR 4.3; 95%CI: 0.96-18.84, p = 0.057). CONCLUSION: A score>/=5 among patients fulfilling WHO-criteria had a PPV of 100% for a detectable VL and 90% for viral failure. In settings without regular access to VL-testing, this PPV may be considered high enough to switch this patient-group to second-line treatment without confirmatory VL-test. en
dc.language English en
dc.subject Viral diseases en
dc.subject HIV en
dc.subject AIDS en
dc.subject HAART en
dc.subject Antiretrovirals en
dc.subject Treatment failure en
dc.subject Prediction en
dc.subject Clinical prediction rule en
dc.subject WHO en
dc.subject Criteria en
dc.subject Predictive value en
dc.subject Exposure en
dc.subject CD4 lymphocyte count en
dc.subject Hemoglobin concentration en
dc.subject Pruritis en
dc.subject Compliance en
dc.subject Retention en
dc.subject Viral load en
dc.subject Viral suppression en
dc.subject Second-line drugs en
dc.subject Lesotho en
dc.subject Africa, Southern en
dc.title A clinical prediction score in addition to WHO criteria for anti-retroviral treatment failure in resource-limited settings - experience from Lesotho en
dc.type Article-E en
dc.citation.issue 10 en
dc.citation.jtitle PLoS ONE en
dc.citation.volume 7 en
dc.citation.pages e47937 en
dc.citation.jabbreviation PLoS ONE en

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