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

Davies, Mary-Ann; Boulle, Andrew; Technau, Karl; Eley, Brian; Moultrie, Harry; Rabie, Helena; Garone, Daniela; Giddy, Janet; Wood, Robin; Egger, Matthias; Keiser, Olivia; IeDEA, Southern Africa Collaboration (2012). The role of targeted viral load testing in diagnosing virological failure in children on antiretroviral therapy with immunological failure. Tropical medicine and international health TM&IH, 17(11), pp. 1386-1390. Oxford: Blackwell Science 10.1111/j.1365-3156.2012.03073.x

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

UniBE Contributor:

Egger, Matthias and Keiser, Olivia

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1360-2276

Publisher:

Blackwell Science

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:35

Last Modified:

10 Sep 2017 01:51

Publisher DOI:

10.1111/j.1365-3156.2012.03073.x

PubMed ID:

22974345

Web of Science ID:

000310028400011

BORIS DOI:

10.7892/boris.13953

URI:

https://boris.unibe.ch/id/eprint/13953 (FactScience: 220673)

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