NDLI: Validation of a clinical prediction score to target viral load testing in adults with suspected first-line treatment failure in resource-constrained settings.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Phan, Vichet Thai, Sopheak Koole, Olivier Menten, Joris Meheus, Filip Van Griensven, Johan Lynen, Lutgarde
Spatial Coverage	Cambodia
Description	Country affiliation: Cambodia Author Affiliation: Phan V ( Department of Infectious Diseases, Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.)
Abstract	BACKGROUND: Although routine viral load (VL) monitoring currently is too costly for poor countries, clinical failure criteria perform poorly. We previously developed an algorithm combining a clinical predictor score (CPS) with targeted VL testing in a Cambodian patient population (derivation population). We now prospectively validate the algorithm in the same clinical setting (validation population), assess its operational performance, and explore its cost-saving potential. METHODS: We performed a cross-sectional study in a tertiary hospital in Phnom Penh, Cambodia, applying the CPS in adults on first-line antiretroviral treatment for at least 1 year. Treatment failure was defined as a VL >1000 copies per milliliter. The area under the receiver-operating characteristic (AUROC) curve of the CPS to detect treatment failure in the current study population (validation population) was compared with the AUROC of the CPS obtained in the patient population where the CPS was derived from in 2008 in the same study setting (derivation population). Costs related to VL testing and second-line regimens with the different testing strategies were compared. RESULTS: One thousand four hundred ninety individuals {56.6% female, median age 38 years [interquartile range (IQR): 33-44]} were included, with a median baseline CD4 cell count of 94 cells per microliter (IQR: 28-205). Median time on antiretroviral treatment was 3.6 years (IQR: 2.1-5.1), 45 (3.0%) individuals had treatment failure. The AUROC of the CPS in validation was 0.75 (95% confidence interval: 0.67 to 0.83), relative to an AUROC of 0.70 in the derivation population. At the CPS cutoff ≥ 2, VL was indicated for 164 (11%) individuals, preventing inappropriate switching to second line in 143 cases. Twenty-four cases of treatment failure would be missed. When applied in routine care, the AUROC was 0.69 (95% confidence interval: 0.60 to 0.77). Overall 1-year program costs with targeted VL testing were 4-fold reduced. CONCLUSIONS: The algorithm performed well in validation and has cost-saving potential. Further studies to assess its performance, feasibility, and impact in different settings are warranted.
File Format	HTM / HTML
ISSN	15254135
Issue Number	5
Volume Number	62
e-ISSN	10779450
Journal	JAIDS Journal of Acquired Immune Deficiency Syndromes
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2013-04-15
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline AIDS Algorithms Anti-hiv Agents Therapeutic Use Hiv Infections Drug Therapy Virology Hiv-1 Growth & Development Isolation & Purification Adult Area Under Curve Cd4 Lymphocyte Count Cambodia Cross-sectional Studies Female Economics Immunology Genetics Humans Longitudinal Studies Male Rna, Viral Chemistry Roc Curve Real-time Polymerase Chain Reaction Viral Load Comparative Study Journal Article Research Support, Non-u.s. Gov't Validation Studies
Content Type	Text
Resource Type	Article
Subject	Infectious Diseases Pharmacology (medical)

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