Computational models can predict response to HIV therapy without a genotype and may reduce treatment failure in different resource-limited settings

Objectives: Genotypic HIV drug-resistance testing is typically 60%-65% predictive of response to combination antiretroviral therapy (ART) and is valuable for guiding treatment changes. Genotyping is unavailable in many resource-limited settings (RLSs). We aimed to develop models that can predict response to ART without a genotype and evaluated their potential as a treatment support tool in RLSs. Methods: Random forest models were trained to predict the probability of response to ART (≤400 copies HIV RNA/mL) using the following data from 14891 treatment change episodes (TCEs) after virological failure, from well-resourced countries: viral load and CD4 count prior to treatment change, treatment history, drugs in the new regimen, time to follow-up and follow-up viral load. Models were assessed by cross-validation during development, with an independent set of 800 cases fromwell-resourced countries, plus 231 cases fromSouthern Africa, 206 from India and 375 from Romania. The area under the receiver operating characteristic curve (AUC) was the main outcome measure. Results: Themodels achieved an AUC of 0.74-0.81 during cross-validation and 0.76-0.77 with the 800 test TCEs. They achievedAUCs of 0.58-0.65 (Southern Africa), 0.63 (India) and 0.70 (Romania).Modelsweremore accurate for data fromthewell-resourced countries than for cases fromSouthern Africa and India (P<0.001), but not Romania. The models identified alternative, available drug regimens predicted to result in virological response for 94% of virological failures in Southern Africa, 99% of those in India and 93% of those in Romania. Conclusions: We developed computational models that predict virological response to ART without a genotype with comparable accuracy to genotyping with rule-based interpretation. These models have the potential to help optimize antiretroviral therapy for patients in RLSs where genotyping is not generally available ©The Author 2013.