|
5th International AIDS Society Conference on HIV Pathogenesis and TreatmentCape Town - July 19 - 22, 2009 |
WHAT IS THE BENEFIT OF CONFIRMING DIAGNOSED IMMUNOLOGICAL FAILURE WITH VIROLOGICAL TESTING IN ART PATIENTS TREATED IN RURAL MALAWI?
IAS Conf HIV Pathog Treat 2009 Jul 19-22;5th: Abstract No. MOPDD105
M. McGuire1, R. Kanaphathipillai
1, R. Mogha1, M. Le Paih2, M. Stover1, B. Méa1, E. Szumilin3, A. Heinzelmann3, E. Mbale4, M. Pujades-Rodríguez5,6
1Médecins Sans Frontières, Chiradzulu, Malawi, 2Médecins Sans Frontières, Blantyre, Malawi, 3Médecins Sans Frontières, Paris, France, 4Ministry of Health, Chiradzulu, Malawi, 5Epicentre, Paris, France, 6University of Bern (ISPM), Bern, Switzerland
BACKGROUND: In most resource limited settings diagnosis of treatment failure is based on WHO clinical or immunological criteria. However, discordance between immunological and virological indicators may lead to premature switching to second-line therapy. In 2008 Médecins Sans Frontières began confirming cases of immunological failure with viral load (VL) testing before switching treatment. We evaluated the benefit of this strategy.
METHODS: We used routinely collected data from adults (≥15 years) treated with first-line antiretroviral regimens for >6 months and diagnosed with immunological failure between September and December 2008. Immunological failure was defined as a CD4 decline to either baseline or <50% of on-treatment peak values, or persistent CD4 <100 copies/mm3 after 1 year of treatment. We determined the positive predictive values of immunological failure criteria to diagnose virological failure (HIV RNA ≥10,000).
RESULTS: Overall, 318 patients met the immunologic failure criteria after a median of 28 months on ART. At initiation, median baseline CD4 was 170 copies/mm3, 19% with WHO stage 4. At suspicion of failure median CD4 count was 148 copies/mm3 and 12% had BMI <17.5 kg/m2; most patients (73%) were on nevirapine (NVP) + stavudine (d4T) + lamivudine (3TC). Of 114 (36%) patients with VL results, 33(28%) were undetectable (under 50), 29 (25%) 51-999, 28(25%) 1,000-9,999 and 24(21%) ≥10,000 HIV RNA copies/mL. Positive predictive values of immunological failure criteria to detect virological failure were 21% and 50% for =10,000 and >1,000 VL thresholds, respectively.
CONCLUSIONS: Overall the immunological criteria performed poorly, approximately one third had an undetectable VL and less than a quarter of patients diagnosed with immunological failure had virological failure (as defined by >10,000 HIV RNA copies/mL). Changing treatment on the only basis of immunological criteria would have led to the premature switch of a substantial proportion of patients.
Download PDF of this abstract.
Download Power Point Presentation.
2009-07-22
MOPDD105
Operations Research to Improve Laboratory Diagnosis and Monitoring
Copyright © 2009 - International AIDS Society (IAS). All information and content relating to the abstracts from the 5th International AIDS Society Conference on HIV Pathogenesis and Treatment, such as text, graphics, logos, button icons, images, audio clips, and software is protected by copyright. Permission is hereby granted for the non-commercial use or reproduction of the information on this web site, provided that the use of such information is accompanied by an acknowledgement that IAS is the source of the information and the name of the author of the article.
AEGiS is a 501(c)3, not-for-profit, tax-exempt, educational corporation. AEGiS is made possible through unrestricted funding from the Elton John AIDS Foundation, National Library of Medicine, AIDS Walk of Orange County, and donations from users like you. Always watch for outdated information. This article first appeared in 2009. This material is designed to support, not replace, the relationship that exists between you and your doctor.
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Copyright ©1980, 2009. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. Permission is hereby granted for the non-commercial use or reproduction of the information herein, provided that the use of such information is accompanied by an acknowledgement that IAS is the source of the information and the name of the author of the article.