Positive Predictive Value of the WHO Clinical and Immunologic Criteria to Predict Viral Load Failure among Adults on First, or Second-Line Antiretroviral Therapy in Kenya
| العنوان: | Positive Predictive Value of the WHO Clinical and Immunologic Criteria to Predict Viral Load Failure among Adults on First, or Second-Line Antiretroviral Therapy in Kenya |
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| المؤلفون: | Julie A Okonji, Lucy Ng’ang’a, Anthony Waruru, Marta Ackers, Tolbert Ayuaya, Andrea A. Kim, Fredrick Miruka, Opiyo Erick, Sandra Schwarcz, Hellen Muttai |
| المصدر: | PLoS ONE, Vol 11, Iss 7, p e0158881 (2016) PLoS ONE |
| بيانات النشر: | Public Library of Science (PLoS), 2016. |
| سنة النشر: | 2016 |
| مصطلحات موضوعية: | Male, RNA viruses, Pathology, Research Facilities, lcsh:Medicine, HIV Infections, Pathology and Laboratory Medicine, Geographical Locations, 0302 clinical medicine, Immunodeficiency Viruses, Medicine and Health Sciences, Public and Occupational Health, Treatment Failure, 030212 general & internal medicine, Young adult, lcsh:Science, Multidisciplinary, Middle Aged, Viral Load, Prognosis, Vaccination and Immunization, Predictive value, 3. Good health, Medical Microbiology, Viral Pathogens, Predictive value of tests, Viruses, Tuberculosis Diagnosis and Management, Female, Pathogens, Research Laboratories, Developed country, Viral load, Research Article, Adult, medicine.medical_specialty, Adolescent, Anti-HIV Agents, Immunology, 030231 tropical medicine, Antiretroviral Therapy, World Health Organization, Research and Analysis Methods, Sensitivity and Specificity, Microbiology, Young Adult, 03 medical and health sciences, Antiviral Therapy, Predictive Value of Tests, Diagnostic Medicine, Virology, Internal medicine, Retroviruses, medicine, Humans, Microbial Pathogens, Treatment Guidelines, Health Care Policy, business.industry, Lentivirus, lcsh:R, Organisms, Biology and Life Sciences, HIV, Kenya, Antiretroviral therapy, Confidence interval, Health Care, Regimen, Specimen Preparation and Treatment, People and Places, Africa, lcsh:Q, Preventive Medicine, business, Viral Transmission and Infection, Government Laboratories |
| الوصف: | Routine HIV viral load (VL) monitoring is the standard of care for persons receiving antiretroviral therapy (ART) in developed countries. Although the World Health Organization recommends annual VL monitoring of patients on ART, recognizing difficulties in conducting routine VL testing, the WHO continues to recommend targeted VL testing to confirm treatment failure for persons who meet selected immunologic and clinical criteria. Studies have measured positive predictive value (PPV), negative predictive value, sensitivity and specificity of these criteria among patients receiving first-line ART but not specifically among those on second-line or subsequent regimens. Between 2008 and 2011, adult ART patients in Nyanza, Kenya who met national clinical or immunologic criteria for treatment failure received targeted VL testing. We calculated PPV and 95% confidence intervals (CI) of these criteria to detect virologic treatment failure among patients receiving a) first-line ART, b) second/subsequent ART, and c) any regimen. Of 12,134 patient specimens tested, 2,874 (23.7%) were virologically confirmed as treatment failures. The PPV for 2,834 first-line ART patients who met either the clinical or immunologic criteria for treatment failure was 34.4% (95% CI 33.2–35.7), 33.1% (95% CI 24.7–42.3) for the 40 patients on second-line/subsequent regimens, and 33.4% (95% CI 33.1–35.6) for any ART. PPV, regardless of criteria, for first-line ART patients was lowest among patients over 44 years old and highest for patients aged 15 to 34 years. PPV of immunological and clinical criteria for correctly identifying treatment failure was similarly low for adult patients receiving either first-line or second-line/subsequent ART regimens. Our data confirm the inadequacy of clinical and immunologic criteria to correctly identify treatment failure and support the implementation of routine VL testing. |
| اللغة: | English |
| تدمد: | 1932-6203 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::85effeabcec61b5906f9d2899ceda9ba http://europepmc.org/articles/PMC4934908?pdf=render |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....85effeabcec61b5906f9d2899ceda9ba |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19326203 |
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