Development and evaluation of a clinical algorithm to monitor patients on antiretrovirals in resource-limited settings using adherence, clinical and CD4 cell count criteria.
Development and evaluation of a clinical algorithm to monitor patients on antiretrovirals in resource-limited settings using adherence, clinical and CD4 cell count criteria.
复制标题
DOI：
10.1186/1758-2652-12-3
复制
发表时间：
2009-03-04
影响因子：
6
通讯作者：
Reynolds SJ
中科院分区：
文献类型：
--
作者：
Meya D;Spacek LA;Tibenderana H;John L;Namugga I;Magero S;Dewar R;Quinn TC;Colebunders R;Kambugu A;Reynolds SJ
在大多数资源有限的环境中，无法承担对接受抗逆转录病毒治疗 (ART) 的患者进行常规病毒载量监测。乌干达坎帕拉传染病研究所对 496 名接受 ART 的乌干达人进行了横断面研究。通过多变量逻辑回归评估依从性、临床和实验室参数与病毒失败的关系。构建了使用靶向病毒载量测试的临床算法来识别接受二线 ART 的患者。该算法与世界卫生组织 (WHO) 指南进行了比较，后者使用临床和免疫学标准来识别在没有病毒载量测试的情况下的失败。 49 例 (10%) 的病毒载量 >400 拷贝/mL，39 例 (8%) 的病毒载量 >1000 拷贝/mL。结合坚持失败（中断 >2 天）和 CD4 失败（从峰值下降 30%）的算法，对于病毒载量 >1000 拷贝/mL 的敏感性为 67%，特异性为 82%，并确定了 22% 的患者进行病毒载量检测。基于 WHO 的算法的敏感性为 31%，特异性为 87%，将导致 14% 的病毒抑制患者（<400 拷贝/mL）被不适当地转为二线 ART。使用依从性、临床和 CD4 标准的算法可以更好地分配病毒载量测试，减少继续接受 ART 失败的患者数量，并限制耐药性的发展。
Routine viral load monitoring of patients on antiretroviral therapy (ART) is not affordable in most resource-limited settings. A cross-sectional study of 496 Ugandans established on ART was performed at the Infectious Diseases Institute, Kampala, Uganda. Adherence, clinical and laboratory parameters were assessed for their relationship with viral failure by multivariate logistic regression. A clinical algorithm using targeted viral load testing was constructed to identify patients for second-line ART. This algorithm was compared with the World Health Organization (WHO) guidelines, which use clinical and immunological criteria to identify failure in the absence of viral load testing. Forty-nine (10%) had a viral load of >400 copies/mL and 39 (8%) had a viral load of >1000 copies/mL. An algorithm combining adherence failure (interruption >2 days) and CD4 failure (30% fall from peak) had a sensitivity of 67% for a viral load of >1000 copies/mL, a specificity of 82%, and identified 22% of patients for viral load testing. Sensitivity of the WHO-based algorithm was 31%, specificity was 87%, and would result in 14% of those with viral suppression (<400 copies/mL) being switched inappropriately to second-line ART. Algorithms using adherence, clinical and CD4 criteria may better allocate viral load testing, reduce the number of patients continued on failing ART, and limit the development of resistance.
登录
查看更多内容
影响因子：
6.4
作者：
HUGHES, MD;STEIN, DS;VOLBERDING, PA
通讯作者：
VOLBERDING, PA
影响因子：
11.8
作者：
Ivers, LC;Kendrick, D;Doucette, K
通讯作者：
Doucette, K
影响因子：
11.8
作者：
Khanna, Nina;Opravil, Milos;Kaufmann, Gilbert R.
通讯作者：
Kaufmann, Gilbert R.
影响因子：
6.4
作者：
Gross, Robert;Yip, Benita;Hogg, Robert S.
通讯作者：
Hogg, Robert S.
影响因子：
3.8
作者：
Coetzee, D;Hildebrand, K;Goemaere, E
通讯作者：
Goemaere, E