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BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2016

Open Access 01-12-2016 | Research article

Predicting resistance as indicator for need to switch from first-line antiretroviral therapy among patients with elevated viral loads: development of a risk score algorithm

Authors: Sarah E. Rutstein, Mina C. Hosseinipour, Morris Weinberger, Stephanie B. Wheeler, Andrea K. Biddle, Carole L. Wallis, Pachamuthu Balakrishnan, John W. Mellors, Mariza Morgado, Shanmugam Saravanan, Srikanth Tripathy, Saran Vardhanabhuti, Joseph J. Eron, William C. Miller

Published in: BMC Infectious Diseases | Issue 1/2016

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Abstract

Background

In resource-limited settings, where resistance testing is unavailable, confirmatory testing for patients with high viral loads (VL) delays antiretroviral therapy (ART) switches for persons with resistance. We developed a risk score algorithm to predict need for ART change by identifying resistance among persons with persistently elevated VL.

Methods

We analyzed data from a Phase IV open-label trial. Using logistic regression, we identified demographic and clinical characteristics predictive of need for ART change among participants with VLs ≥1000 copies/ml, and assigned model-derived scores to predictors. We designed three models, including only variables accessible in resource-limited settings.

Results

Among 290 participants with at least one VL ≥1000 copies/ml, 51 % (148/290) resuppressed and did not have resistance testing; among those who did not resuppress and had resistance testing, 47 % (67/142) did not have resistance and 53 % (75/142) had resistance (ART change needed for 25.9 % (75/290)). Need for ART change was directly associated with higher baseline VL and higher VL at time of elevated measure, and inversely associated with treatment duration. Other predictors included body mass index and adherence. Area under receiver operating characteristic curves ranged from 0.794 to 0.817. At a risk score ≥9, sensitivity was 14.7–28.0 % and specificity was 96.7–98.6 %.

Conclusions

Our model performed reasonably well and may be a tool to quickly transition persons in need of ART change to more effective regimens when resistance testing is unavailable. Use of this algorithm may result in public health benefits and health system savings through reduced transmissions of resistant virus and costs on laboratory investigations.
Appendix
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Metadata
Title
Predicting resistance as indicator for need to switch from first-line antiretroviral therapy among patients with elevated viral loads: development of a risk score algorithm
Authors
Sarah E. Rutstein
Mina C. Hosseinipour
Morris Weinberger
Stephanie B. Wheeler
Andrea K. Biddle
Carole L. Wallis
Pachamuthu Balakrishnan
John W. Mellors
Mariza Morgado
Shanmugam Saravanan
Srikanth Tripathy
Saran Vardhanabhuti
Joseph J. Eron
William C. Miller
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2016
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-016-1611-2

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