ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2011
Immunologic criteria are poor predictors of virologic outcome: implications for HIV treatment monitoring in resource-limited settings.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 86 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
86 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The performance of using dried blood spot specimens for HIV-1 viral load testing: A systematic review and meta-analysis.PLoS medicine · 2022Pooled it
- Persistent difficulties in switching to second-line ART in sub-saharan Africa--a systematic review and meta-analysis.PloS one · 2013Pooled it
- Virologic response of treatment experienced HIV-infected Ugandan children and adolescents on NNRTI based first-line regimen, previously monitored without viral load.BMC pediatrics · 2021Trial
- Can HIV reverse transcriptase activity assay be a low-cost alternative for viral load monitoring in resource-limited settings?BMJ open · 2016Trial
- The Impact of Different CD4 Cell-Count Monitoring and Switching Strategies on Mortality in HIV-Infected African Adults on Antiretroviral Therapy: An Application of Dynamic Marginal Structural Models.American journal of epidemiology · 2015Trial
- Incidence and predictors of first line antiretroviral regimen modification in western Kenya.PloS one · 2014Trial
- Switching HIV treatment in adults based on CD4 count versus viral load monitoring: a randomized, non-inferiority trial in Thailand.PLoS medicine · 2013Trial
- Cost effectiveness analysis of clinically driven versus routine laboratory monitoring of antiretroviral therapy in Uganda and Zimbabwe.PloS one · 2012Trial
- Serum Interleukin-6 and Interleukin-10 levels in people living with HIV on short-term and long-term antiretroviral therapy: a comparative cross-sectional study with HIV-negative controls.BMC infectious diseases · 2026Article
- Antiretroviral therapy regimen modification rates and associated factors in a cohort of HIV/AIDS patients in Asmara, Eritrea: a 16-year retrospective analysis.Scientific reports · 2023Article
- Predictors of Viral Load and Medication Adherence Among HIV-Positive Adults Under Treatment at Felege-Hiwot Comprehensive Specialized Hospital, North-West, Ethiopia.HIV/AIDS (Auckland, N.Z.) · 2023Article
- Virological and Immunological Antiretroviral Treatment Failure and Predictors Among HIV Positive Adult and Adolescent Clients in Southeast Ethiopia.HIV/AIDS (Auckland, N.Z.) · 2022Article
- Design and Development of a Risk Classification Instrument for Virological Failure in HIV, Using Psychosocial Determinants of Health: Preliminary Evidence from a South American Country.AIDS and behavior · 2021Article
- Field evaluation of HIV-1 viral load monitoring in adults and children receiving antiretroviral treatment in Nigeria by dried blood spot testing with RealTime HIV-1 on m2000.Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology · 2021Article
- Brazilian Protocol for Sexually Transmitted Infections, 2020: HIV infection in adolescents and adults.Revista da Sociedade Brasileira de Medicina Tropical · 2021Article
- Predictors of first-line antiretroviral therapy failure among adults and adolescents living with HIV/AIDS in a large prevention and treatment program in Nigeria.AIDS research and therapy · 2020Article
- Increased Virological Failure and Determinants Among HIV Patients on Highly Active Retroviral Therapy in Adigrat General Hospital, Northern Ethiopia, 2019: Hospital-Based Cross-Sectional Study.Infection and drug resistance · 2020Article
- HIV and development of epithelial cell abnormalities in women with prior normal cervical cytology in Nigeria.Infectious agents and cancer · 2020Article
- Observational
- Reasons for first line ART modification over the years during the ART scale up in Uganda.AIDS research and therapy · 2019Article
26 more citing papers are in PubMed but not listed here.
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Authors and funding
16 authors.
Funding
Abstract
backgroundViral load (VL) quantification is considered essential for determining antiretroviral treatment (ART) success in resource-rich countries. However, it is not widely available in resource-limited settings where the burden of human immunodeficiency virus infection is greatest. In the absence of VL monitoring, switches to second-line ART are based on World Health Organization (WHO) clinical or immunologic failure criteria.
methodsWe assessed the performance of CD4 cell criteria to predict virologic outcomes in a large ART program in Nigeria. Laboratory monitoring consists of CD4 cell count and VL at baseline, then every 6 months. Failure was defined as 2 consecutive VLs >1000 copies/mL after at least 6 months of ART. Virologic outcomes were compared with the 3 WHO-defined immunologic failure criteria.
resultsA total of 9690 patients were included in the analysis (median follow-up, 33.2 months). A total of 1225 patients experienced failure by both immunologic and virologic criteria, 872 by virologic criteria only, and 1897 by immunologic criteria only. The sensitivity of CD4 cell criteria to detect viral failure was 58%, specificity was 75%, and the positive-predictive value was 39%. For patients with both virologic and immunologic failure, VL criteria identified failure significantly earlier than CD4 cell criteria (median, 10.4 vs 15.6 months; P < .0001).
conclusionsBecause of the low sensitivity of immunologic criteria, a substantial number of failures are missed, potentially resulting in accumulation of resistance mutations. In addition, specificity and predictive values are low, which may result in large numbers of unnecessary ART switches. Monitoring solely by immunologic criteria may result in increased costs because of excess switches to more expensive ART and development of drug-resistant virus.
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