Simplified clinical prediction scores to target viral load testing in adults with suspected first line treatment failure in Phnom Penh, Cambodia.
Simplified clinical prediction scores to target viral load testing in adults with suspected first line treatment failure in Phnom Penh, Cambodia.
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DOI：
10.1371/journal.pone.0087879
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发表时间：
2014
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：
van Griensven J;Phan V;Thai S;Koole O;Lynen L
对于实验室能力有限的环境，2013年世界卫生组织（WHO）指南建议进行有针对性的HIV-1病毒载量（VL）检测，以确定病毒学失败。我们之前开发并验证了靶向VL检测的临床预测评分（CPS），该评分依赖于临床、依从性和实验室数据。虽然它优于世卫组织的失败标准，但它需要大量计算和审查所有以前的实验室测试。作为回应，我们开发了四个简化的，不易出错的和广泛适用的CPS版本，可以在现场完成。结果从2010年5月至2011年6月，我们验证了原来的CPS在非政府医院在金边，柬埔寨应用CPS成人一线治疗>1年。病毒学失败定义为单个VL >1000拷贝/ml。4种CPS包括CPS 1，其“当前CD 4计数”而非CD 4峰值下降%; CPS 2，其血红蛋白测量值被删除; CPS 3，其“CD 4计数下降至基线值以下”被删除; CPS 4为纯临床。评分制定依赖于Spiegelhalter/Knill-Jones方法。保留与病毒学失败独立相关的变量，似然比≥1.5或≤0.67。根据ROC曲线下面积（AUROC）和95%置信区间（CI）评价CPS性能。CPS在独立数据集中进行了验证。共纳入1490例受试者（56.6%为女性，中位年龄：38岁（四分位距（IQR 33-44））;中位基线CD 4计数：94个细胞/µL（IQR 28-205），抗逆转录病毒治疗中位时间3.6年（IQR 2.1-5.1））。45例（3.0%）患者病毒学失败。在验证中，CPS 1产生的AUROC为0.69（95% CI：0.62-0.75），CPS 2产生的AUROC为0.68（95% CI：0.62-0.74），CPS 3产生的AUROC为0.67（95% CI：0.61-0.73）。纯临床CPS 4表现不佳（AUROC-0.59; 95% CI：0.53-0.65）。只要包括当前的CD 4计数检测，简化的CPS保持可接受的准确度。现场应用的便利性和现场准确性仍有待确定。
For settings with limited laboratory capacity, 2013 World Health Organization (WHO) guidelines recommend targeted HIV-1 viral load (VL) testing to identify virological failure. We previously developed and validated a clinical prediction score (CPS) for targeted VL testing, relying on clinical, adherence and laboratory data. While outperforming the WHO failure criteria, it required substantial calculation and review of all previous laboratory tests. In response, we developed four simplified, less error-prone and broadly applicable CPS versions that can be done ‘on the spot’. Findings From May 2010 to June 2011, we validated the original CPS in a non-governmental hospital in Phnom Penh, Cambodia applying the CPS to adults on first-line treatment >1 year. Virological failure was defined as a single VL >1000 copies/ml. The four CPSs included CPS1 with ‘current CD4 count’ instead of %-decline-from-peak CD4; CPS2 with hemoglobin measurements removed; CPS3 having ‘decrease in CD4 count below baseline value’ removed; CPS4 was purely clinical. Score development relied on the Spiegelhalter/Knill-Jones method. Variables independently associated with virological failure with a likelihood ratio ≥1.5 or ≤0.67 were retained. CPS performance was evaluated based on the area-under-the-ROC-curve (AUROC) and 95% confidence intervals (CI). The CPSs were validated in an independent dataset. A total of 1490 individuals (56.6% female, median age: 38 years (interquartile range (IQR 33–44)); median baseline CD4 count: 94 cells/µL (IQR 28–205), median time on antiretroviral therapy 3.6 years (IQR 2.1–5.1)), were included. Forty-five 45 (3.0%) individuals had virological failure. CPS1 yielded an AUROC of 0.69 (95% CI: 0.62–0.75) in validation, CPS2 an AUROC of 0.68 (95% CI: 0.62–0.74), and CPS3, an AUROC of 0.67 (95% CI: 0.61–0.73). The purely clinical CPS4 performed poorly (AUROC-0.59; 95% CI: 0.53–0.65). Simplified CPSs retained acceptable accuracy as long as current CD4 count testing was included. Ease of field application and field accuracy remains to be defined.
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影响因子：
4.1
作者：
Lynen, Lutgarde;Van Griensven, Johan;Elliott, Julian
通讯作者：
Elliott, Julian
影响因子：
6
作者：
Meya D;Spacek LA;Tibenderana H;John L;Namugga I;Magero S;Dewar R;Quinn TC;Colebunders R;Kambugu A;Reynolds SJ
通讯作者：
Reynolds SJ
跟踪艾滋病毒的进展：护理点测试对抗逆转录病毒疗法的影响。
影响因子：
3.9
作者：
Reid SD;Fidler SJ;Cooke GS
通讯作者：
Cooke GS
影响因子：
3.7
作者：
Labhardt ND;Lejone T;Setoko M;Poka M;Ehmer J;Pfeiffer K;Kiuvu PZ;Lynen L
通讯作者：
Lynen L
DOI：
10.1093/trstmh/trt001
发表时间：
2013-04-01
影响因子：
2.2
作者：
Choun, Kimcheng;Thai, Sopheak;van Griensven, Johan
通讯作者：
van Griensven, Johan