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Diagnostic accuracy of CD4 cell count increase for virologic response after initiating highly active antiretroviral therapy.
AIDS 2006; 20(12):1613-9AIDS

Abstract

OBJECTIVE

To derive and internally validate a clinical prediction rule for virologic response based on CD4 cell count increase after initiation of HAART in a resource-limited setting.

DESIGN AND METHODS

A retrospective cohort study at two HIV care clinics in Gaborone, Botswana. The participants were previously treatment-naive HIV-1-infected individuals initiating HAART. The main outcome measure was a plasma HIV-1 RNA level (viral load) < or = 400 copies/ml (i.e. undetectable) 6 months after initiating HAART.

RESULTS

The ability of CD4 cell count increase to predict an undetectable viral load was significantly better in those with baseline CD4 cell counts < or = 100 cells/microl [area under the ROC curve (AUC), 0.78; 95% confidence interval (CI), 0.67-0.89; versus AUC, 0.60; 95% CI, 0.48-0.71; P = 0.018]. The sensitivity, specificity, and positive and negative predictive values of a CD4 cell count increase of > or = 50 cells/microl for an undetectable viral load in those with baseline CD4 cell counts < or = 100 cells/microl were 93.1, 61.3, 92.5 and 63.3%, respectively. Alternatively, these values were 47.8, 87.1, 95.0 and 24.5%, respectively, if a increase in CD4 cell count of > or = 150 cells/microl was used.

CONCLUSIONS

CD4 cell count increase after initiating HAART has only moderate discriminative ability in identifying patients with an undetectable viral load, and the predictive ability is higher [corrected] in patients with lower baseline CD4 cell counts. Although HIV treatment programs in resource-constrained settings could consider the use of CD4 cell count increases to triage viral load testing, more accurate approaches to monitoring virologic failure are urgently needed.

Authors+Show Affiliations

Department of Medicine, Division of Infectious Diseases, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania19104-6021, USA. gregbisson@mac.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

16868442

Citation

Bisson, Gregory P., et al. "Diagnostic Accuracy of CD4 Cell Count Increase for Virologic Response After Initiating Highly Active Antiretroviral Therapy." AIDS (London, England), vol. 20, no. 12, 2006, pp. 1613-9.
Bisson GP, Gross R, Strom JB, et al. Diagnostic accuracy of CD4 cell count increase for virologic response after initiating highly active antiretroviral therapy. AIDS. 2006;20(12):1613-9.
Bisson, G. P., Gross, R., Strom, J. B., Rollins, C., Bellamy, S., Weinstein, R., ... Ndwapi, N. (2006). Diagnostic accuracy of CD4 cell count increase for virologic response after initiating highly active antiretroviral therapy. AIDS (London, England), 20(12), pp. 1613-9.
Bisson GP, et al. Diagnostic Accuracy of CD4 Cell Count Increase for Virologic Response After Initiating Highly Active Antiretroviral Therapy. AIDS. 2006 Aug 1;20(12):1613-9. PubMed PMID: 16868442.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic accuracy of CD4 cell count increase for virologic response after initiating highly active antiretroviral therapy. AU - Bisson,Gregory P, AU - Gross,Robert, AU - Strom,Jordan B, AU - Rollins,Caitlin, AU - Bellamy,Scarlett, AU - Weinstein,Rachel, AU - Friedman,Harvey, AU - Dickinson,Diana, AU - Frank,Ian, AU - Strom,Brian L, AU - Gaolathe,Tendani, AU - Ndwapi,Ndwapi, PY - 2006/7/27/pubmed PY - 2006/11/11/medline PY - 2006/7/27/entrez SP - 1613 EP - 9 JF - AIDS (London, England) JO - AIDS VL - 20 IS - 12 N2 - OBJECTIVE: To derive and internally validate a clinical prediction rule for virologic response based on CD4 cell count increase after initiation of HAART in a resource-limited setting. DESIGN AND METHODS: A retrospective cohort study at two HIV care clinics in Gaborone, Botswana. The participants were previously treatment-naive HIV-1-infected individuals initiating HAART. The main outcome measure was a plasma HIV-1 RNA level (viral load) < or = 400 copies/ml (i.e. undetectable) 6 months after initiating HAART. RESULTS: The ability of CD4 cell count increase to predict an undetectable viral load was significantly better in those with baseline CD4 cell counts < or = 100 cells/microl [area under the ROC curve (AUC), 0.78; 95% confidence interval (CI), 0.67-0.89; versus AUC, 0.60; 95% CI, 0.48-0.71; P = 0.018]. The sensitivity, specificity, and positive and negative predictive values of a CD4 cell count increase of > or = 50 cells/microl for an undetectable viral load in those with baseline CD4 cell counts < or = 100 cells/microl were 93.1, 61.3, 92.5 and 63.3%, respectively. Alternatively, these values were 47.8, 87.1, 95.0 and 24.5%, respectively, if a increase in CD4 cell count of > or = 150 cells/microl was used. CONCLUSIONS: CD4 cell count increase after initiating HAART has only moderate discriminative ability in identifying patients with an undetectable viral load, and the predictive ability is higher [corrected] in patients with lower baseline CD4 cell counts. Although HIV treatment programs in resource-constrained settings could consider the use of CD4 cell count increases to triage viral load testing, more accurate approaches to monitoring virologic failure are urgently needed. SN - 0269-9370 UR - https://www.unboundmedicine.com/medline/citation/16868442/Diagnostic_accuracy_of_CD4_cell_count_increase_for_virologic_response_after_initiating_highly_active_antiretroviral_therapy_ L2 - http://Insights.ovid.com/pubmed?pmid=16868442 DB - PRIME DP - Unbound Medicine ER -