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Home >> Publications >> The role of targeted viral load testing in diagnosing virological failure in children on antiretroviral therapy with immunological failure.

Publication

Author(s):

Davies MA, Boulle A, Technau K, Eley B, Moultrie H, Rabie H, Garone D, Giddy J, Wood R, Egger M, Keiser O; for the IeDEA Southern Africa Collaboration.

Pub Title:

The role of targeted viral load testing in diagnosing virological failure in children on antiretroviral therapy with immunological failure.

Pub Date:

Nov 30 2012

Pub Region(s):

Southern Africa

Journal Issue:

Epub

Page Number:
Epub

Journal:

Title: 
Tropical Medicine and International Health
Link: 
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2012.03073.x/abstract

PubMed: 22974345
Pub PDF: PDF icon 22974345.pdf

Abstract
Objectives: To determine the improvement in positive predictive value of immunological failure criteria for identifying virological failure in HIV-infected children on antiretroviral therapy (ART) when a single targeted viral load measurement is performed in children identified as having immunological failure. Methods  Analysis of data from children (<16 years at ART initiation) at South African ART sites at which CD4 count/per cent and HIV-RNA monitoring are performed 6-monthly. Immunological failure was defined according to both WHO 2010 and United States Department of Health and Human Services (DHHS) 2008 criteria. Confirmed virological failure was defined as HIV-RNA >5000 copies/ml on two consecutive occasions <365 days apart in a child on ART for ≥18 months. Results  Among 2798 children on ART for ≥18 months [median (IQR) age 50 (21-84) months at ART initiation], the cumulative probability of confirmed virological failure by 42 months on ART was 6.3%. Using targeted viral load after meeting DHHS immunological failure criteria rather than DHHS immunological failure criteria alone increased positive predictive value from 28% to 82%. Targeted viral load improved the positive predictive value of WHO 2010 criteria for identifying confirmed virological failure from 49% to 82%. Conclusion  The addition of a single viral load measurement in children identified as failing immunologically will prevent most switches to second-line treatment in virologically suppressed children.

© 2012 Blackwell Publishing Ltd.

KEYWORDS:

HIV, VIH, antiretroviral therapy, antirétroviral, children, enfants, fallo inmunológico, fallo virológico, immunological failure, monitoring, monitorización, niños, suivi, terapia antirretroviral, thérapie, virological failure, échec immunologique, échec virologique VIH

PMID: 22974345 [PubMed - in process]

PMCID: PMC3830726

 
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Citation:

Davies MA, Boulle A, Technau K, Eley B, Moultrie H, Rabie H, Garone D, Giddy J, Wood R, Egger M, Keiser O; IeDEA Southern Africa Collaboration. The role of targeted viral load testing in diagnosing virological failure in children on antiretroviral therapy with immunological failure. Trop Med Int Health. 2012 Nov;17(11):1386-90. doi: 10.1111/j.1365-3156.2012.03073.x. Epub 2012 Sep 14. PubMed PMID: 22974345; PubMed Central PMCID: PMC3830726.