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Journal of the International AIDS Society
Published in: Journal of the International AIDS Society 1/2009

Open Access 01-12-2009 | Research

Development and evaluation of a clinical algorithm to monitor patients on antiretrovirals in resource-limited settings using adherence, clinical and CD4 cell count criteria

Authors: David Meya, Lisa A Spacek, Hilda Tibenderana, Laurence John, Irene Namugga, Stephen Magero, Robin Dewar, Thomas C Quinn, Robert Colebunders, Andrew Kambugu, Steven J Reynolds

Published in: Journal of the International AIDS Society | Issue 1/2009

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Abstract

Background

Routine viral load monitoring of patients on antiretroviral therapy (ART) is not affordable in most resource-limited settings.

Methods

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.

Results

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.

Conclusion

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.
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Metadata
Title
Development and evaluation of a clinical algorithm to monitor patients on antiretrovirals in resource-limited settings using adherence, clinical and CD4 cell count criteria
Authors
David Meya
Lisa A Spacek
Hilda Tibenderana
Laurence John
Irene Namugga
Stephen Magero
Robin Dewar
Thomas C Quinn
Robert Colebunders
Andrew Kambugu
Steven J Reynolds
Publication date
01-12-2009
Publisher
BioMed Central
Published in
Journal of the International AIDS Society / Issue 1/2009
Electronic ISSN: 1758-2652
DOI
https://doi.org/10.1186/1758-2652-12-3

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