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Home >> Publications >> Risk Charts to Guide Targeted HIV-1 Viral Load Monitoring of ART: Development and Validation in Patients From Resource-Limited Settings

Publication

Author(s):

Koller M1, Fatti G, Chi BH, Keiser O, Hoffmann CJ, Wood R, Prozesky H, Stinson K, Giddy J, Mutevedzi P, Fox M, Law M, Boulle A, Egger M.

Pub Title:

Risk Charts to Guide Targeted HIV-1 Viral Load Monitoring of ART: Development and Validation in Patients From Resource-Limited Settings

Pub Date:

Jul 7 2015

Pub Region(s):

Multiregional, Southern Africa

Journal:

Title: 
JAIDS Journal of Acquired Immune Deficiency Syndromes
Link: 
http://pt.wkhealth.com/pt/re/lwwgateway/landingpage.htm;jsessionid=X1NZQdnyByy9jsXwMdQFZZ1Wh1wJKv2NfPNrvjLPgH0P7H0K5tn7!-1552860756!181195628!8091!-1?sid=WKPTLP:landingpage&an=00126334-201511010-00021

PubMed: 26181811
Pub PDF:

BACKGROUND: HIV-1 RNA viral load (VL) testing is recommended to monitor antiretroviral therapy (ART) but not available in many resource-limited settings. We developed and validated CD4-based risk charts to guide targeted VL testing.

METHODS: We modeled the probability of virologic failure up to 5 years of ART based on current and baseline CD4 counts, developed decision rules for targeted VL testing of 10%, 20% or 40% of patients in seven cohorts of patients starting ART in South Africa, and plotted cut-offs for VL testing on colour-coded risk charts. We assessed the accuracy of risk chart-guided VL testing to detect virologic failure in validation cohorts from South Africa, Zambia and the Asia-Pacific.

FINDINGS: 31,450 adult patients were included in the derivation and 25,294 patients in the validation cohorts. Positive predictive values increased with the percentage of patients tested: from 79% (10% tested) to 98% (40% tested) in the South African, from 64% to 93% in the Zambian and from 73% to 96% in the Asia-Pacific cohorts. Corresponding increases in sensitivity were from 35% to 68% in South Africa, from 55% to 82% in Zambia and from 37% to 71% in Asia-Pacific. The area under the receiver-operating curve increased from 0.75 to 0.91 in South Africa, from 0.76 to 0.91 in Zambia and from 0.77 to 0.92 in Asia Pacific.

INTERPRETATION: CD4-based risk charts with optimal cut-offs for targeted VL testing may be useful to monitor ART in settings where VL capacity is limited.

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Citation:

J Acquir Immune Defic Syndr. 2015 Jul 7. [Epub ahead of print] Risk charts to guide targeted HIV-1 viral load monitoring of ART: development and validation in patients from resource-limited settings. Koller M1, Fatti G, Chi BH, Keiser O, Hoffmann CJ, Wood R, Prozesky H, Stinson K, Giddy J, Mutevedzi P, Fox M, Law M, Boulle A, Egger M.