Evaluation of the WHO criteria for antiretroviral treatment failure among adults in South Africa
- 1 October 2008
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in AIDS
- Vol. 22 (15), 1971-1977
- https://doi.org/10.1097/qad.0b013e32830e4cd8
Abstract
To assess the performance of WHO clinical and CD4 cell count criteria for antiretroviral treatment (ART) failure among HIV-infected adults in a workplace HIV care programme in South Africa. Cohort study. We included initially ART-naive participants who remained on first-line therapy and had an evaluable HIV viral load result at the 12-month visit. WHO-defined clinical and CD4 cell count criteria for ART failure were compared against a gold standard of virological failure. Among 324 individuals (97.5% men, median age 40.2, median starting CD4 cell count and viral load 154 cells/mul and 47,503 copies/ml, respectively), 33 (10.2%) had definite or probable virological failure at 12 months, compared with 19 (6.0%) and 40 (12.5%) with WHO-defined CD4 and clinical failure, respectively. CD4 criteria had a sensitivity of 21.2% and a specificity of 95.8% in detecting virological failure, and clinical criteria had sensitivity of 15.2% and specificity of 88.1%. The positive predictive value of CD4 and clinical criteria in detecting virological failure were 36.8 and 12.8%, respectively. Exclusion of weight loss or tuberculosis failed to improve the performance of clinical criteria. WHO clinical and CD4 criteria have poor sensitivity and specificity in detecting virological failure. The low specificities and positive predictive values mean that individuals with adequate virological suppression risk being incorrectly classified as having treatment failure and unnecessarily switched to second-line therapy. Virological failure should be confirmed before switching to second-line therapy.Keywords
This publication has 12 references indexed in Scilit:
- Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa: A Systematic ReviewPLoS Medicine, 2007
- Establishing a workplace antiretroviral therapy programme in South AfricaAIDS Care, 2007
- Performance of Immunologic Responses in Predicting Viral Load SuppressionJAIDS Journal of Acquired Immune Deficiency Syndromes, 2006
- The WHO public-health approach to antiretroviral treatment against HIV in resource-limited settingsThe Lancet, 2006
- A new model to monitor the virological efficacy of antiretroviral treatment in resource-poor countriesThe Lancet Infectious Diseases, 2006
- Is Moderate HIV Viremia Associated With a Higher Risk of Clinical Progression in HIV-Infected People Treated With Highly Active Antiretroviral TherapyJAIDS Journal of Acquired Immune Deficiency Syndromes, 2006
- Lessons Learned from Use of Highly Active Antiretroviral Therapy in AfricaClinical Infectious Diseases, 2005
- Feasibility and acceptability of a specialist clinical service for HIV-infected mineworkers in South AfricaAIDS Care, 2004
- Duration and predictors of CD4 T-cell gains in patients who continue combination therapy despite detectable plasma viremiaAIDS, 2002
- THE USE OF CONFIDENCE OR FIDUCIAL LIMITS ILLUSTRATED IN THE CASE OF THE BINOMIALBiometrika, 1934