A new model to monitor the virological efficacy of antiretroviral treatment in resource-poor countries.

Infectious Disease Institute, Faculty of Medicine, Makerere University, Kampala, Uganda.
The Lancet Infectious Diseases (Impact Factor: 19.45). 02/2006; 6(1):53-9. DOI: 10.1016/S1473-3099(05)70327-3
Source: PubMed

ABSTRACT Monitoring the efficacy of antiretroviral treatment in developing countries is difficult because these countries have few laboratory facilities to test viral load and drug resistance. Those that exist are faced with a shortage of trained staff, unreliable electricity supply, and costly reagents. Not only that, but most HIV patients in resource-poor countries do not have access to such testing. We propose a new model for monitoring antiretroviral treatment in resource-limited settings that uses patients' clinical and treatment history, adherence to treatment, and laboratory indices such as haemoglobin level and total lymphocyte count to identify virological treatment failure, and offers patients future treatment options. We believe that this model can make an accurate diagnosis of treatment failure in most patients. However, operational research is needed to assess whether this strategy works in practice.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Pruritic papular eruption (PPE) of HIV is common in HIV-infected populations living in the tropics. Its aetiology has been attributed to insect bite reactions and reported to improve with antiretroviral therapy (ART). Its presence after at least 6 months of ART has been proposed as one of several markers of treatment failure. To determine factors associated with PPE in HIV-infected persons receiving ART. Case-control study nested within a 500-person cohort from a teaching hospital in Mbarara, Uganda. Forty-five cases and 90 controls were enrolled. Cases have had ART for ≥15 months and an itchy papular rash for at least one month with microscopic correlation by skin biopsy. Each case was individually matched with two controls on age, sex and ART duration. Twenty-five of 45 (56%) cases had microscopic findings consistent with PPE, defined as PPE cases. At skin examination and biopsy (study enrollment), a similar proportion of PPE cases and matched controls had plasma HIV RNA <400 copies/ml (96% vs. 85%, p=0.31). The odds of being a PPE case increased 4-fold with every log increase in viral load at ART initiation (p=0.02) but not at study enrollment. CD4 counts at ART initiation and study enrollment, and CD4 gains and CD8+T-cell activation measured 6 and 12 months after ART commencement were not associated with PPE cases. Study participants who reported daily insect bites had greater odds of being cases (odds ratio [OR] 8.3, p<0.001) or PPE cases (OR 8.6, p=0.01). PPE in HIV-infected persons receiving ART for ≥15 months was associated with greater HIV viraemia at ART commencement, independent of CD4 count. Skin biopsies are important to distinguish between PPE and other itchy papular eruptions. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 11/2013; DOI:10.1111/bjd.12721 · 3.76 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Several studies from resource-limited settings have demonstrated that clinical and immunologic criteria are poor predictors of virologic failure, confirming the need for viral load monitoring or at least an algorithm to target viral load testing. We used data from an electronic patient management system to develop an algorithm to identify patients at risk of viral failure using a combination of accessible and inexpensive markers.
    Journal of the International AIDS Society 09/2014; 17:19139. DOI:10.7448/IAS.17.1.19139 · 4.21 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Less costly but still accurate methods for monitoring HIV treatment response are needed. We prospectively evaluated if a qualitative polymerase chain reaction (PCR) amplification assay for virologic monitoring could maintain accuracy while reducing costs in Seoul, South Korea. We conducted the first prospective study comparing a qualitative PCR amplification of HIV-1 reverse transcriptase (RT) versus a commercial real time PCR assay (i.e. viral load) for virologic monitoring of 150 patients receiving antiretroviral therapy (ART) between November 2011 and August 2012 at an urban hospital in Seoul, South Korea. A total of 215 blood plasma samples from 150 patients receiving ART for more than 6 months were evaluated. Using the individual viral load assay, 12 of 215 (5.6%) plasma samples had more than 500 HIV RNAcopies/mL. The qualitative PCR amplification assay detected individual samples with ≥ 500 HIV RNA copies/mL with 100% sensitivity. The specificities of the qualitative PCR amplification of HIV-1 RT assay were 94.1%, 93.6%, and 93.2% compared to the real time PCR at 500, 1000, and 5000 threshold of HIV RNA copies/mL, respectively, and $24,940 USD would have been saved for 150 patients during 10 months. The qualitative PCR amplification of HIV-1 RT assay might be a useful approach to effectively monitor patients receiving ART and save resources.
    AIDS research and human retroviruses 04/2014; 30(8). DOI:10.1089/AID.2013.0227 · 2.18 Impact Factor

Full-text (2 Sources)

Available from
May 19, 2014