Pooled HIV-1 RNA Viral Load Testing for Detection of Antiretroviral Treatment Failure in Kenyan children

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  Chohan, Bhavna H. ; Tapia, Kenneth ; Merkel, Michele ; Kariuki, Arphaxad C ; Khasimwa, Brian ; Olago, Agatha ; Gichohi, Richard ; Obimbo, Elizabeth M ; Wamalwa, Dalton C
• Description:
  Background
  
  Pooled viral load (VL) testing with two different testing strategies was evaluated as a potential cost-saving method to monitor antiretroviral therapy (ART) in HIV-infected children receiving ART in a resource-limited setting.
  
  Methods
  
  Archived samples collected from 250 HIV-1 infected children on first-line ART at various time-points post-ART initiation were evaluated for pooled VL testing using a minipool+algorithm strategy. Additionally, samples collected in real-time from 125 children on ART were assessed for virologic failure using a minipool strategy for pooled viral load testing. Virologic failure was determined as HIV-1 RNA viral loads >1500 copies/ml.
  
  Results
  
  Minipool+algorithm strategy for pooled VL testing of archived samples had estimated viral failure of 13.6%, with a relative efficiency (RE) of 23.6% (95% CI; 18.5, 29.4), and negative predictive value (NPV) of 88%. This testing strategy would have resulted in 24% fewer assays needed, for a cost savings of $1,180 per 100 samples. The minipool strategy for pooled viral load testing of samples obtained in real-time yielded an estimated 23.2% of samples with viral failure and a RE of 8.0 % (95% CI; 3.9, 14.2); however had a minipool+algorithm pooling strategy been used the RE would increase to 20%.
  
  Conclusions
  
  The minipool+algorithm strategy for pooled VL testing to detect virologic failure in HIV-1 infected children on ART was determined to be relatively efficient in detecting virologic failure, had high NPV, with substantial cost savings. Pooling strategies may be important components of cost-effect strategies to reduce rates of viral failure and resistance, thus improving clinical outcomes.
  
  
• Subjects:
  Adolescent Algorithms Anti-HIV Agents Article Child Child, Preschool Drug Resistance, Viral Female HIV-1 HIV Infections Humans Infant Kenya Male RNA, Viral Treatment Failure Viral Load

  More +
• Source:
  J Acquir Immune Defic Syndr. 63(3):e87-e93
• Pubmed ID:
  23542638
• Pubmed Central ID:
  PMC3767042
• Document Type:
  Journal Article
• Funding:
  R01 TW007632/TW/FIC NIH HHS/United States ; D43 TW000007/TW/FIC NIH HHS/United States ; R01 D43-TW000007/TW/FIC NIH HHS/United States ; 5U2GPS002182 CDC 2010-2011/PHS HHS/United States ; P30 AI027757/AI/NIAID NIH HHS/United States ; 3R01 TW007632-05S1/TW/FIC NIH HHS/United States ; CCU 024513 CDC 2004-2010/PHS HHS/United States
• Volume:
  63
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:4701db371bda781fec239c1018e776825943239d09f6d2d7ed6d2b0578330850
• Download URL:
  https://stacks.cdc.gov/view/cdc/29725/cdc_29725_DS1.pdf
• File Type:
  [PDF - 475.39 KB ]