A clinical prediction score in addition to WHO criteria for anti-retroviral treatment failure in resource-limited settings - experience from Lesotho

N.D. Labhardt, T. Lejone, M. Setoko, M. Poka, J. Ehmer, K. Pfeiffer, P.Z. Kiuvu, L. Lynen

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Abstract

OBJECTIVE: To assess the positive predictive value (PPV) of a clinical score for viral failure among patients fulfilling the WHO-criteria for anti-retroviral treatment (ART) failure in rural Lesotho. METHODS: Patients fulfilling clinical and/or immunological WHO failure-criteria were enrolled. The score includes the following predictors: Prior ART exposure (1 point), CD4-count below baseline (1), 25% and 50% drop from peak CD4-count (1 and 2), hemoglobin drop>/=1 g/dL (1), CD4 count/=6 months, 134 (11.8%) had immunological and/or clinical failure, 104 (78%) had blood drawn (13 died, 10 lost to follow-up, 7 did not show up). From 92 (88%) a result could be obtained (2 samples hemolysed, 10 lost). Out of these 92 patients 47 (51%) had viral failure (>/=5000 copies), 27 (29%) viral suppression (/=5. A score>/=5 had a PPV of 100% to detect a VL>40 copies (95%CI: 84-100), and of 90% to detect a VL>/=5000 copies (70-97). Within the score, adherence/=5 and 4 (5%) if score/=5 among patients fulfilling WHO-criteria had a PPV of 100% for a detectable VL and 90% for viral failure. In settings without regular access to VL-testing, this PPV may be considered high enough to switch this patient-group to second-line treatment without confirmatory VL-test.
Original languageEnglish
JournalPLoS ONE
Volume7
Issue number10
Pages (from-to)e47937
ISSN1932-6203
DOIs
Publication statusPublished - 2012

Keywords

  • Viral diseases
  • HIV
  • AIDS
  • HAART
  • Antiretrovirals
  • Treatment failure
  • Prediction
  • Clinical prediction rule
  • WHO
  • Criteria
  • Predictive value
  • Exposure
  • CD4 lymphocyte count
  • Hemoglobin concentration
  • Pruritis
  • Compliance
  • Retention
  • Viral load
  • Viral suppression
  • Second-line drugs
  • Lesotho
  • Africa-Southern

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