Accuracy of immunological criteria for identifying virological failure in children on antiretroviral therapy - The IeDEA Southern Africa Collaboration.

Hdl Handle:
http://hdl.handle.net/10144/204589
Title:
Accuracy of immunological criteria for identifying virological failure in children on antiretroviral therapy - The IeDEA Southern Africa Collaboration.
Authors:
Davies, Mary-Ann; Boulle, Andrew; Eley, Brian; Moultrie, Harry; Technau, Karl; Rabie, Helena; van Cutsem, Gilles; Giddy, Janet; Wood, Robin; Egger, Matthias; Keiser, Olivia
Journal:
Tropical Medicine & International Health : TM & IH
Abstract:
Objectives  To determine the diagnostic accuracy of World Health Organization (WHO) 2010 and 2006 as well as United States Department of Health and Human Services (DHHS) 2008 definitions of immunological failure for identifying virological failure (VF) in children on antiretroviral therapy (ART). 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. Incomplete virological suppression (IVS) was defined as failure to achieve ≥1 HIV-RNA ≤400 copies/ml between 6 and 15 months on ART and viral rebound (VR) as confirmed HIV-RNA ≥5000 copies/ml in a child on ART for ≥18 months who had achieved suppression during the first year on treatment. Results  Among 3115 children [median (interquartile range) age 48 (20-84) months at ART initiation] on treatment for ≥1 year, sensitivity of immunological criteria for IVS was 10%, 6% and 26% for WHO 2006, WHO 2010 and DHHS 2008 criteria, respectively. The corresponding positive predictive values (PPV) were 31%, 20% and 20%. Diagnostic accuracy for VR was determined in 2513 children with ≥18 months of follow-up and virological suppression during the first year on ART with sensitivity of 5% (WHO 2006/2010) and 27% (DHHS 2008). PPV results were 42% (WHO 2010), 43% (WHO 2006) and 20% (DHHS 2008). Conclusion  Current immunological criteria are unable to correctly identify children failing ART virologically. Improved access to viral load testing is needed to reliably identify VF in children.
Affiliation:
School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa  Red Cross Children's Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa  Wits Institute for Sexual Reproductive Health, HIV & Related Diseases, University of the Witwatersrand, Johannesburg, South Africa  Empilweni Service and Research Unit, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa  Tygerberg Academic Hospital, University of Stellenbosch, Stellenbosch, South Africa  Khayelitsha ART Programme and Médecins Sans Frontières, Khayelitsha, South Africa  McCord Hospital, Durban, South Africa  Gugulethu Community Health Centre and Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa  Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Issue Date:
11-Aug-2011
URI:
http://hdl.handle.net/10144/204589
DOI:
10.1111/j.1365-3156.2011.02854.x
PubMed ID:
21834797
Language:
en
ISSN:
1365-3156
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorDavies, Mary-Annen
dc.contributor.authorBoulle, Andrewen
dc.contributor.authorEley, Brianen
dc.contributor.authorMoultrie, Harryen
dc.contributor.authorTechnau, Karlen
dc.contributor.authorRabie, Helenaen
dc.contributor.authorvan Cutsem, Gillesen
dc.contributor.authorGiddy, Janeten
dc.contributor.authorWood, Robinen
dc.contributor.authorEgger, Matthiasen
dc.contributor.authorKeiser, Oliviaen
dc.date.accessioned2012-01-24T23:29:48Z-
dc.date.available2012-01-24T23:29:48Z-
dc.date.issued2011-08-11-
dc.identifier.citationAccuracy of immunological criteria for identifying virological failure in children on antiretroviral therapy - The IeDEA Southern Africa Collaboration. 2011: Trop. Med. Int. Healthen
dc.identifier.issn1365-3156-
dc.identifier.pmid21834797-
dc.identifier.doi10.1111/j.1365-3156.2011.02854.x-
dc.identifier.urihttp://hdl.handle.net/10144/204589-
dc.description.abstractObjectives  To determine the diagnostic accuracy of World Health Organization (WHO) 2010 and 2006 as well as United States Department of Health and Human Services (DHHS) 2008 definitions of immunological failure for identifying virological failure (VF) in children on antiretroviral therapy (ART). 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. Incomplete virological suppression (IVS) was defined as failure to achieve ≥1 HIV-RNA ≤400 copies/ml between 6 and 15 months on ART and viral rebound (VR) as confirmed HIV-RNA ≥5000 copies/ml in a child on ART for ≥18 months who had achieved suppression during the first year on treatment. Results  Among 3115 children [median (interquartile range) age 48 (20-84) months at ART initiation] on treatment for ≥1 year, sensitivity of immunological criteria for IVS was 10%, 6% and 26% for WHO 2006, WHO 2010 and DHHS 2008 criteria, respectively. The corresponding positive predictive values (PPV) were 31%, 20% and 20%. Diagnostic accuracy for VR was determined in 2513 children with ≥18 months of follow-up and virological suppression during the first year on ART with sensitivity of 5% (WHO 2006/2010) and 27% (DHHS 2008). PPV results were 42% (WHO 2010), 43% (WHO 2006) and 20% (DHHS 2008). Conclusion  Current immunological criteria are unable to correctly identify children failing ART virologically. Improved access to viral load testing is needed to reliably identify VF in children.en
dc.languageENG-
dc.language.isoenen
dc.rightsArchived on this site with the kind permission of Wiley-Blackwell, [url]http://www.blackwell-synergy.com/loi/tmi[/url]en
dc.titleAccuracy of immunological criteria for identifying virological failure in children on antiretroviral therapy - The IeDEA Southern Africa Collaboration.en
dc.contributor.departmentSchool of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa  Red Cross Children's Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa  Wits Institute for Sexual Reproductive Health, HIV & Related Diseases, University of the Witwatersrand, Johannesburg, South Africa  Empilweni Service and Research Unit, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa  Tygerberg Academic Hospital, University of Stellenbosch, Stellenbosch, South Africa  Khayelitsha ART Programme and Médecins Sans Frontières, Khayelitsha, South Africa  McCord Hospital, Durban, South Africa  Gugulethu Community Health Centre and Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa  Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.en
dc.identifier.journalTropical Medicine & International Health : TM & IHen

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