Benefit of viral load testing for confirmation of immunological failure in HIV patients treated in rural Malawi.

Hdl Handle:
http://hdl.handle.net/10144/204591
Title:
Benefit of viral load testing for confirmation of immunological failure in HIV patients treated in rural Malawi.
Authors:
Kanapathipillai, Rupa; McGuire, Megan; Mogha, Robert; Szumilin, Elisabeth; Heinzelmann, Annette; Pujades-Rodriguez, Mar
Journal:
Tropical Medicine & International Health : TM & IH
Abstract:
Objective  Viral load testing is used in the HIV programme of Chiradzulu, Malawi, to confirm the diagnosis of immunological failure to prevent unnecessary switching to second-line therapy. Our objective was to quantify the benefit of this strategy for management of treatment failure in a large decentralized HIV programme in Africa. Methods  Retrospective analysis of monitoring data from adults treated with first-line antiretroviral regimens for >1 year and meeting the WHO immunological failure criteria in an HIV programme in rural Malawi. The positive predictive value of using immunological failure criteria to diagnose virological failure (viral load >5000 copies/ml) was estimated. Results  Of the 227 patients with immunological failure (185 confirmed with a repeat CD4 measurement), 155 (68.2%) had confirmatory viral load testing. Forty-four (28.4%) had viral load >5000 copies/ml and 57 (36.8%) >1000 copies/ml. Positive predictive value was 28.4% (95% CI 21.4-36.2%). Repeat CD4 count testing showed that 41% of patients initially diagnosed with immunological failure did no longer meet failure criteria. Conclusions  Our results support the need for confirming all cases of immunological failure with viral load testing before switching to second-line ART to optimize the use of resources in developing countries.
Affiliation:
Médecins Sans Frontières, Chiradzulu, Malawi  Monash Medical Centre, Clayton, Vic., Australia  Epicentre, Paris, France  Médecins Sans Frontières, Paris, France.
Issue Date:
1-Sep-2011
URI:
http://hdl.handle.net/10144/204591
DOI:
10.1111/j.1365-3156.2011.02874.x
PubMed ID:
21883726
Language:
en
ISSN:
1365-3156
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorKanapathipillai, Rupaen
dc.contributor.authorMcGuire, Meganen
dc.contributor.authorMogha, Roberten
dc.contributor.authorSzumilin, Elisabethen
dc.contributor.authorHeinzelmann, Annetteen
dc.contributor.authorPujades-Rodriguez, Maren
dc.date.accessioned2012-01-24T23:35:03Z-
dc.date.available2012-01-24T23:35:03Z-
dc.date.issued2011-09-01-
dc.identifier.citationBenefit of viral load testing for confirmation of immunological failure in HIV patients treated in rural Malawi. 2011: Trop. Med. Int. Healthen
dc.identifier.issn1365-3156-
dc.identifier.pmid21883726-
dc.identifier.doi10.1111/j.1365-3156.2011.02874.x-
dc.identifier.urihttp://hdl.handle.net/10144/204591-
dc.description.abstractObjective  Viral load testing is used in the HIV programme of Chiradzulu, Malawi, to confirm the diagnosis of immunological failure to prevent unnecessary switching to second-line therapy. Our objective was to quantify the benefit of this strategy for management of treatment failure in a large decentralized HIV programme in Africa. Methods  Retrospective analysis of monitoring data from adults treated with first-line antiretroviral regimens for >1 year and meeting the WHO immunological failure criteria in an HIV programme in rural Malawi. The positive predictive value of using immunological failure criteria to diagnose virological failure (viral load >5000 copies/ml) was estimated. Results  Of the 227 patients with immunological failure (185 confirmed with a repeat CD4 measurement), 155 (68.2%) had confirmatory viral load testing. Forty-four (28.4%) had viral load >5000 copies/ml and 57 (36.8%) >1000 copies/ml. Positive predictive value was 28.4% (95% CI 21.4-36.2%). Repeat CD4 count testing showed that 41% of patients initially diagnosed with immunological failure did no longer meet failure criteria. Conclusions  Our results support the need for confirming all cases of immunological failure with viral load testing before switching to second-line ART to optimize the use of resources in developing countries.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.titleBenefit of viral load testing for confirmation of immunological failure in HIV patients treated in rural Malawi.en
dc.contributor.departmentMédecins Sans Frontières, Chiradzulu, Malawi  Monash Medical Centre, Clayton, Vic., Australia  Epicentre, Paris, France  Médecins Sans Frontières, Paris, France.en
dc.identifier.journalTropical Medicine & International Health : TM & IHen

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