ArticlePloS one2012
A clinical prediction score in addition to WHO criteria for anti-retroviral treatment failure in resource-limited settings--experience from Lesotho.
Article in PloS one, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Accuracy of measures for antiretroviral adherence in people living with HIV.The Cochrane database of systematic reviews · 2022Pooled it
- Biological parameters determining the effectiveness of monitoring of HIV / AIDS infected patients in Morocco.African health sciences · 2023Article
- Clinical and immunological failure among HIV-positive adults taking first-line antiretroviral therapy in Dire Dawa, eastern Ethiopia.BMC public health · 2019Article
- A targeted approach for routine viral load monitoring in Malawian adults on antiretroviral therapy.Tropical medicine & international health : TM & IH · 2018Article
- Alcohol use and depression: link with adherence and viral suppression in adult patients on antiretroviral therapy in rural Lesotho, Southern Africa: a cross-sectional study.BMC public health · 2016Observational
- The predictive value of current haemoglobin levels for incident tuberculosis and/or mortality during long-term antiretroviral therapy in South Africa: a cohort study.BMC medicine · 2015Article
- Resolution of anaemia in a cohort of HIV-infected patients with a high prevalence and incidence of tuberculosis receiving antiretroviral therapy in South Africa.BMC infectious diseases · 2014Article
- HIV-associated anemia after 96 weeks on therapy: determinants across age ranges in Uganda and Zimbabwe.AIDS research and human retroviruses · 2014Article
- Factors associated with pruritic papular eruption of human immunodeficiency virus infection in the antiretroviral therapy era.The British journal of dermatology · 2014Article
- Article
- CD4 criteria improves the sensitivity of a clinical algorithm developed to identify viral failure in HIV-positive patients on antiretroviral therapy.Journal of the International AIDS Society · 2014Article
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8 authors.
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Abstract
objectiveTo assess the positive predictive value (PPV) of a clinical score for viral failure among patients fulfilling the WHO-criteria for anti-retroviral treatment (ART) failure in rural Lesotho.
methodsPatients fulfilling clinical and/or immunological WHO failure-criteria were enrolled. The score includes the following predictors: Prior ART exposure (1 point), CD4-count below baseline (1), 25% and 50% drop from peak CD4-count (1 and 2), hemoglobin drop≥1 g/dL (1), CD4 count<100/µl after 12 months (1), new onset papular pruritic eruption (1), and adherence<95% (3). A nurse assessed the score the day blood was drawn for viral load (VL). Reported confidence intervals (CI) were calculated using Wilsons method.
resultsAmong 1'131 patients on ART ≥ 6 months, 134 (11.8%) had immunological and/or clinical failure, 104 (78%) had blood drawn (13 died, 10 lost to follow-up, 7 did not show up). From 92 (88%) a result could be obtained (2 samples hemolysed, 10 lost). Out of these 92 patients 47 (51%) had viral failure (≥ 5000 copies), 27 (29%) viral suppression (<40) and 18 (20%) intermediate viremia (40-4999). Overall, 20 (22%) had a score ≥ 5. A score ≥ 5 had a PPV of 100% to detect a VL>40 copies (95%CI: 84-100), and of 90% to detect a VL ≥ 5000 copies (70-97). Within the score, adherence<95%, CD4-count<100/µl and papular pruritic eruption were the strongest single predictors. Among 47 patients failing, 8 (17%) died before or within 4 weeks after being switched. Overall mortality was 4 (20%) among those with score ≥ 5 and 4 (5%) if score<5 (OR 4.3; 95%CI: 0.96-18.84, p = 0.057).
conclusionA score ≥ 5 among patients fulfilling WHO-criteria had a PPV of 100% for a detectable VL and 90% for viral failure. In settings without regular access to VL-testing, this PPV may be considered high enough to switch this patient-group to second-line treatment without confirmatory VL-test.
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