A clinical prediction score in addition to WHO criteria for anti-retroviral treatment failure in resource-limited settings--experience from Lesotho.
A clinical prediction score in addition to WHO criteria for anti-retroviral treatment failure in resource-limited settings--experience from Lesotho.
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DOI：
10.1371/journal.pone.0047937
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Lynen L
中科院分区：
文献类型：
--
作者：
Labhardt ND;Lejone T;Setoko M;Poka M;Ehmer J;Pfeiffer K;Kiuvu PZ;Lynen L
评估在莱索托农村地区符合世卫组织抗逆转录病毒治疗(ART)失败标准的患者中，病毒失败的临床评分的阳性预测价值(PPV)。符合临床和/或免疫学WHO失败标准的患者入选。评分包括以下预测因素：既往技术暴露(1分)，CD_4计数低于基线(1分)，CD_4计数较峰值下降25%和50%(1分和2分)，血红蛋白下降1g/dL(1分)，12个月后CD_4计数100/微克L(1分)，新发丘疹(1分)，粘连95%(3分)。一名护士在抽血检测病毒载量(VL)的当天进行了评分。用Wilsons法计算报告可信区间(CI)。在接受ART≥治疗6个月的1‘131例患者中，134例(11.8%)免疫和/或临床失败，104例(78%)抽血(13例死亡，10例失访，7例未出现)。92例(88%)可获得结果(溶血2例，丢失10例)。在92例患者中，有47例(51%)病毒衰竭(≥5000拷贝)，27例(29%)病毒抑制(40例)和18例(20%)中度病毒血症(40-4999)。总体而言，20例(22%)的≥评分为5分。≥5分检测VL>；40拷贝的PPV值为100%(95%可信区间：84-100)，检测VL≥5000拷贝的PPV值为90%(70-97)。在评分中，依从性及95%、CD_4细胞计数及L百分率及丘疹瘙痒样皮疹是最强的单一预测因子。在47例失败的患者中，8例(17%)在转换前或转换后4周内死亡。在≥评分为5分和5分的患者中，总死亡率为4(20%)和4(5%)(OR4.3；95%CI：0.9618.84，p = 0.057)。在符合世卫组织标准的≥评分为5的患者中，可检测到的VL的PPV值为100%，病毒失败的PPV值为90%。在没有定期进行VL检测的情况下，这种PPV可能被认为足够高，可以在没有确认性VL检测的情况下将该患者组切换到二线治疗。
To 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. Patients 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. Among 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). A 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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马拉维抗逆转录病毒计划中的二线治疗：早期死亡率很高，但幸存者的结果良好，尽管基线时具有广泛的耐药性。
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作者：
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