Risk charts to guide targeted HIV-1 viral load monitoring of art: Development and validation in patients from resource-limited settings

behalf of the International epidemiologic Databases to Evaluate AIDS in Southern Africa (IeDEA-SA) and the TREAT Asia HIV Observational Database (TAHOD)

Research output: Contribution to journalArticle

Abstract

Background: HIV-1 RNA viral load (VL) testing is recommended to monitor antiretroviral therapy (ART) but not available in many resource-limited settings. We developed and validated CD4-based risk charts to guide targeted VL testing. Methods: We modeled the probability of virologic failure up to 5 years of ART based on current and baseline CD4 counts, developed decision rules for targeted VL testing of 10%, 20%, or 40% of patients in 7 cohorts of patients starting ART in South Africa, and plotted cutoffs for VL testing on colour-coded risk charts. We assessed the accuracy of risk chart-guided VL testing to detect virologic failure in validation cohorts from South Africa, Zambia, and the Asia-Pacific. Results: In total, 31,450 adult patients were included in the derivation and 25,294 patients in the validation cohorts. Positive predictive values increased with the percentage of patients tested: from 79% (10% tested) to 98% (40% tested) in the South African cohort, from 64% to 93% in the Zambian cohort, and from 73% to 96% in the Asia-Pacific cohort. Corresponding increases in sensitivity were from 35% to 68% in South Africa, from 55% to 82% in Zambia, and from 37% to 71% in Asia-Pacific. The area under the receiver operating curve increased from 0.75 to 0.91 in South Africa, from 0.76 to 0.91 in Zambia, and from 0.77 to 0.92 in Asia-Pacific. Conclusions: CD4-based risk charts with optimal cutoffs for targeted VL testing maybe useful to monitor ART in settings where VL capacity is limited.

Original languageEnglish (US)
Pages (from-to)e110-e119
JournalJournal of acquired immune deficiency syndromes
Volume70
Issue number3
DOIs
StatePublished - 2015

Keywords

  • Antiretroviral therapy
  • CD4 cell counts
  • HIV-1 RNA viral load
  • Monitoring
  • Risk charts
  • Sub-Saharan Africa
  • Tripartite decision rules

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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    behalf of the International epidemiologic Databases to Evaluate AIDS in Southern Africa (IeDEA-SA) and the TREAT Asia HIV Observational Database (TAHOD) (2015). Risk charts to guide targeted HIV-1 viral load monitoring of art: Development and validation in patients from resource-limited settings. Journal of acquired immune deficiency syndromes, 70(3), e110-e119. https://doi.org/10.1097/QAI.0000000000000748