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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Failure of immunologic criteria to appropriately identify antiretroviral treatment failure in Uganda
AIDS, Volume 23, No. 6, Year 2009
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Description
Objective: Most antiretroviral treatment program in resource-limited settings use immunologic or clinical monitoring to measure response to therapy and to decide when to change to a second-line regimen. Our objective was to evaluate immunologic failure criteria against gold standard virologic monitoring. Design: Observational cohort. Methods: Participants enrolled in an antiretroviral treatment program in rural Uganda who had at least 6 months of follow-up were included in this analysis. Immunologic monitoring was performed by CD4 cell counts every 3 months during the first year, and every 6 months thereafter. HIV-1 viral loads were performed every 6 months. Results: A total of 1133 participants enrolled in the Rakai Health Sciences Program antiretroviral treatment program between June 2004 and September 2007 were followed for up to 44.4 months (median follow-up 20.2 months; IQR 12.4-29.5 months). WHO immunologic failure criteria were reached by 125 (11.0%) participants. A virologic failure endpoint defined as HIV-1 viral load more than 400copies/ml on two measurements was reached by 112 participants (9.9%). Only 26 participants (2.3%) experienced both an immunologic and virologic failure endpoint (2 viral load > 400 copies/ml) during follow-up. Conclusion: Immunologic failure criteria performed poorly in our setting and would have resulted in a substantial proportion of participants with suppressed HIV-1 viral load being switched unnecessarily. These criteria also lacked sensitivity to identify participants failing virologically. Periodic viral load measurements may be a better marker for treatment failure in our setting. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Reynolds, Steven James
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
United States, Baltimore
Johns Hopkins School of Medicine
Nakigozi, Gertrude F.
Uganda, Kalisizo
Rakai Health Sciences Program
Newell, Kevin
United States, Frederick
Saic-frederick
Ndyanabo, Anthony
Uganda, Kalisizo
Rakai Health Sciences Program
Galiwongo, Ronald
Uganda, Kalisizo
Rakai Health Sciences Program
Boaz, Iga
Uganda, Kalisizo
Rakai Health Sciences Program
Quinn, Thomas Charles
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
United States, Baltimore
Johns Hopkins School of Medicine
Gray, Ronald H.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Wawer, Maria J.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Serwadda, David Musoke
Uganda, Kampala
Makerere University
Statistics
Citations: 206
Authors: 10
Affiliations: 6
Identifiers
Doi:
10.1097/QAD.0b013e3283262a78
Research Areas
Infectious Diseases
Study Design
Cohort Study
Study Locations
Uganda