Antiretroviral concentration measurements as an additional tool to manage virologic failure in resource limited settings: a case control study
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
AIDS research and therapy
Abstract
Several studies demonstrate a correlation between sub-therapeutic concentrations of antiretroviral
drugs and virologic failure. We examined the sensitivity, specificity and predictive values of sub-therapeutic drug
levels in predicting viralogic failure.
Methods: This was a case control study with cases being samples of participants with virologic failure, and controls
samples of participants with virologic suppression. We analyzed samples obtained from participants that had been on
antiretroviral treatment (ART) for at least 6 months. Virologic failure was defined as HIV-RNA viral load ≥ 1000 copies/
ml. Sub-therapeutic drug levels were defined according to published reference cutoffs. The diagnostic validity of drug
levels for virologic failure was assessed using plasma viral loads as a gold standard.
Results: Sub-therapeutic ART concentrations explained only 38.2% of virologic failure with a probability of experiencing
virologic failure of 0.66 in a patient with low drug levels versus 0.25 for participants with measurements within
or above the normal range. Approximately 90% of participants with ART concentrations above the lower clinical cut
off did not have virologic failure.
Conclusions: These results support prior indication for therapeutic drug monitoring in cases of suspected virologic
failure.
Description
Keywords
Virologic failure, Therapeutic drug monitoring, Resource limited setting, HIV
Citation
Buzibye, A., Musaazi, J., Von Braun, A., Nanzigu, S., Sekaggya-Wiltshire, C., Kambugu, A., ... & Castelnuovo, B. (2019). Antiretroviral concentration measurements as an additional tool to manage virologic failure in resource limited settings: a case control study. AIDS research and therapy, 16(1), 1-5. https://doi.org/10.1186/s12981-019-0255-x