The role of targeted viral load testing in diagnosing virological failure in children on antiretroviral therapy with immunological failure.

Hdl Handle:
http://hdl.handle.net/10144/255350
Title:
The role of targeted viral load testing in diagnosing virological failure in children on antiretroviral therapy with immunological failure.
Authors:
Davies, Mary-Ann; Boulle, Andrew; Technau, Karl; Eley, Brian; Moultrie, Harry; Rabie, Helena; Garone, Daniela; Giddy, Janet; Wood, Robin; Egger, Matthias; Keiser, Olivia
Journal:
Tropical Medicine & International Health : TM & IH
Abstract:
Objectives  To determine the improvement in positive predictive value of immunological failure criteria for identifying virological failure in HIV-infected children on antiretroviral therapy (ART) when a single targeted viral load measurement is performed in children identified as having immunological failure. 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. Immunological failure was defined according to both WHO 2010 and United States Department of Health and Human Services (DHHS) 2008 criteria. Confirmed virological failure was defined as HIV-RNA >5000 copies/ml on two consecutive occasions <365 days apart in a child on ART for ≥18 months. Results  Among 2798 children on ART for ≥18 months [median (IQR) age 50 (21-84) months at ART initiation], the cumulative probability of confirmed virological failure by 42 months on ART was 6.3%. Using targeted viral load after meeting DHHS immunological failure criteria rather than DHHS immunological failure criteria alone increased positive predictive value from 28% to 82%. Targeted viral load improved the positive predictive value of WHO 2010 criteria for identifying confirmed virological failure from 49% to 82%. Conclusion  The addition of a single viral load measurement in children identified as failing immunologically will prevent most switches to second-line treatment in virologically suppressed children.
Affiliation:
School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa  Empilweni Service and Research Unit, Rahima Moosa Mother and Child Hospital and University of Witwatersrand, Johannesburg, South Africa  Red Cross Children's Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa  Wits Reproductive Health and HIV Institute (Harriet Shezi Children's Clinic, Chris Hani Baragwanath Hospital, Soweto), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa  Tygerberg Academic Hospital, University of Stellenbosch, Stellenbosch, South Africa  Médecins Sans Frontières South Africa and Khayelitsha ART Programme, Khayelitsha, Cape Town, South Africa  Sinikithemba Clinic, 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 (ISPM), University of Bern, Bern, Switzerland.
Issue Date:
14-Sep-2012
URI:
http://hdl.handle.net/10144/255350
DOI:
10.1111/j.1365-3156.2012.03073.x
PubMed ID:
22974345
Additional Links:
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2012.03073.x/abstract;jsessionid=8CEC162F2C518133AA59744BF32FA561.d01t02?systemMessage=Wiley+Online+Library+will+be+disrupted+on+15+December+from+10%3A00-12%3A00+GMT+%2805%3A00-07%3A00+EST%29+for+essential+maintenance
Type:
Article
Language:
en
ISSN:
1365-3156
Appears in Collections:
TB

Full metadata record

DC FieldValue Language
dc.contributor.authorDavies, Mary-Annen_GB
dc.contributor.authorBoulle, Andrewen_GB
dc.contributor.authorTechnau, Karlen_GB
dc.contributor.authorEley, Brianen_GB
dc.contributor.authorMoultrie, Harryen_GB
dc.contributor.authorRabie, Helenaen_GB
dc.contributor.authorGarone, Danielaen_GB
dc.contributor.authorGiddy, Janeten_GB
dc.contributor.authorWood, Robinen_GB
dc.contributor.authorEgger, Matthiasen_GB
dc.contributor.authorKeiser, Oliviaen_GB
dc.date.accessioned2012-12-11T20:49:42Z-
dc.date.available2012-12-11T20:49:42Z-
dc.date.issued2012-09-14-
dc.identifier.citationThe role of targeted viral load testing in diagnosing virological failure in children on antiretroviral therapy with immunological failure. 2012: Trop. Med. Int. Healthen_GB
dc.identifier.issn1365-3156-
dc.identifier.pmid22974345-
dc.identifier.doi10.1111/j.1365-3156.2012.03073.x-
dc.identifier.urihttp://hdl.handle.net/10144/255350-
dc.description.abstractObjectives  To determine the improvement in positive predictive value of immunological failure criteria for identifying virological failure in HIV-infected children on antiretroviral therapy (ART) when a single targeted viral load measurement is performed in children identified as having immunological failure. 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. Immunological failure was defined according to both WHO 2010 and United States Department of Health and Human Services (DHHS) 2008 criteria. Confirmed virological failure was defined as HIV-RNA >5000 copies/ml on two consecutive occasions <365 days apart in a child on ART for ≥18 months. Results  Among 2798 children on ART for ≥18 months [median (IQR) age 50 (21-84) months at ART initiation], the cumulative probability of confirmed virological failure by 42 months on ART was 6.3%. Using targeted viral load after meeting DHHS immunological failure criteria rather than DHHS immunological failure criteria alone increased positive predictive value from 28% to 82%. Targeted viral load improved the positive predictive value of WHO 2010 criteria for identifying confirmed virological failure from 49% to 82%. Conclusion  The addition of a single viral load measurement in children identified as failing immunologically will prevent most switches to second-line treatment in virologically suppressed children.en_GB
dc.languageENG-
dc.language.isoenen
dc.relation.urlhttp://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2012.03073.x/abstract;jsessionid=8CEC162F2C518133AA59744BF32FA561.d01t02?systemMessage=Wiley+Online+Library+will+be+disrupted+on+15+December+from+10%3A00-12%3A00+GMT+%2805%3A00-07%3A00+EST%29+for+essential+maintenanceen_GB
dc.rightsArchived on this site with the kind permission of Wiley-Blackwell, [url]http://www.blackwell-synergy.com/loi/tmi[/url]en_GB
dc.subjectHIV/AIDSen_GB
dc.titleThe role of targeted viral load testing in diagnosing virological failure in children on antiretroviral therapy with immunological failure.en
dc.typeArticleen
dc.contributor.departmentSchool of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa  Empilweni Service and Research Unit, Rahima Moosa Mother and Child Hospital and University of Witwatersrand, Johannesburg, South Africa  Red Cross Children's Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa  Wits Reproductive Health and HIV Institute (Harriet Shezi Children's Clinic, Chris Hani Baragwanath Hospital, Soweto), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa  Tygerberg Academic Hospital, University of Stellenbosch, Stellenbosch, South Africa  Médecins Sans Frontières South Africa and Khayelitsha ART Programme, Khayelitsha, Cape Town, South Africa  Sinikithemba Clinic, 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 (ISPM), University of Bern, Bern, Switzerland.en_GB
dc.identifier.journalTropical Medicine & International Health : TM & IHen_GB

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