Risk charts to guide targeted HIV-1 viral load monitoring of ART: development and validation in patients from resource-limited settings.

Koller, Manuel; Fatti, Geoffrey; Chi, Benjamin H; Keiser, Olivia; Hoffmann, Christopher J; Wood, Robin; Prozesky, Hans; Stinson, Kathryn; Giddy, Janet; Mutevedzi, Portia; Fox, Matthew; Law, Matthew; Boulle, Andrew; Egger, Matthias (2015). Risk charts to guide targeted HIV-1 viral load monitoring of ART: development and validation in patients from resource-limited settings. Journal of acquired immune deficiency syndromes JAIDS, 70(3), e110-e119. Lippincott Williams & Wilkins 10.1097/QAI.0000000000000748

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

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

UniBE Contributor:

Koller, Manuel; Keiser, Olivia and Egger, Matthias

Subjects:

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

ISSN:

0894-9255

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

13 Aug 2015 15:57

Last Modified:

02 Nov 2016 02:30

Publisher DOI:

10.1097/QAI.0000000000000748

PubMed ID:

26181811

BORIS DOI:

10.7892/boris.71006

URI:

https://boris.unibe.ch/id/eprint/71006

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