Skip to main content

Free Content Benefit of viral load testing for confirmation of immunological failure in HIV patients treated in rural Malawi

Download Article:

You have access to the full text article on a website external to Ingenta Connect.

Please click here to view this article on Wiley Online Library.

You may be required to register and activate access on Wiley Online Library before you can obtain the full text. If you have any queries please visit Wiley Online Library

Abstract:

Summary

Objective  Viral load testing is used in the HIV programme of Chiradzulu, Malawi, to confirm the diagnosis of immunological failure to prevent unnecessary switching to second‐line therapy. Our objective was to quantify the benefit of this strategy for management of treatment failure in a large decentralized HIV programme in Africa.

Methods  Retrospective analysis of monitoring data from adults treated with first‐line antiretroviral regimens for >1 year and meeting the WHO immunological failure criteria in an HIV programme in rural Malawi. The positive predictive value of using immunological failure criteria to diagnose virological failure (viral load >5000 copies/ml) was estimated.

Results  Of the 227 patients with immunological failure (185 confirmed with a repeat CD4 measurement), 155 (68.2%) had confirmatory viral load testing. Forty‐four (28.4%) had viral load >5000 copies/ml and 57 (36.8%) >1000 copies/ml. Positive predictive value was 28.4% (95% CI 21.4–36.2%). Repeat CD4 count testing showed that 41% of patients initially diagnosed with immunological failure did no longer meet failure criteria.

Conclusions  Our results support the need for confirming all cases of immunological failure with viral load testing before switching to second‐line ART to optimize the use of resources in developing countries.

Language: English

Document Type: Research Article

DOI: https://doi.org/10.1111/j.1365-3156.2011.02874.x

Affiliations: 1:  Epicentre, Paris, France 2:  Médecins Sans Frontières, Chiradzulu, Malawi 3:  Médecins Sans Frontières, Paris, France

Publication date: 2011-12-01

  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content
Cookie Policy
X
Cookie Policy
Ingenta Connect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more