Failure of immunologic criteria to appropriately identify antiretroviral treatment failure in Uganda

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dc.contributor.authorReynolds, Steven J.
dc.contributor.authorNakigozi, Gertrude
dc.contributor.authorNewell, Kevin
dc.contributor.authorNdyanabo, Anthony
dc.contributor.authorRonald, Galiwongo
dc.contributor.authorIga, Boaz
dc.contributor.author. Quinn, Thomas C
dc.contributor.authorGray, Ron
dc.contributor.authorWawer, Maria
dc.contributor.authorSerwadda, David
dc.date.accessioned2022-02-05T11:12:50Z
dc.date.available2022-02-05T11:12:50Z
dc.date.issued2009-03
dc.description.abstractObjective—Most antiretroviral treatment program in resource-limited settings use immunologic or clinical monitoring to measure response to therapy and to decide when to change to a second line regimen. Our objective was to evaluate immunologic failure criteria against gold standard virologic monitoring. Design—Observation cohort Methods—Participants enrolled in an antiretroviral treatment program in rural Uganda who had at least 6 months of follow-up were included in this analysis. Immunologic monitoring was performed by CD4 cell counts every 3 months during the first year, and every 6 months thereafter. HIV-1 viral loads were performed every 6 months. Results—1133 participants enrolled in the Rakai Health Sciences Program antiretroviral treatment program between June 2004 and September 2007 were followed for up to 44.4 months (median follow-up 20.2 months; IQR 12.4–29.5 months). WHO immunologic failure criteria were reached by 125 (11.0%) participants. A virologic failure endpoint defined as HIV-1 viral load (VL) >400 copies/ml on two measurements was reached by 112 participants (9.9%). Only 26 participants (2.3%) experienced both an immunologic and virologic failure endpoint (2 VL>400 copies/ml) during follow-up. Conclusions—Immunologic failure criteria performed poorly in our setting and would have resulted in a substantial proportion of participants with suppressed HIV-1 VL being switched unnecessarily. These criteria also lacked sensitivity to identify participants failing virologically. Periodic viral load measurements may be a better marker for treatment failure in our settingen_US
dc.identifier.citationReynolds, S. J., Nakigozi, G., Newell, K., Ndyanabo, A., Galiwongo, R., Boaz, I., ... & Serwadda, D. (2009). Failure of immunologic criteria to appropriately identify antiretroviral treatment failure in Uganda. AIDS (London, England), 23(6), 697.doi:10.1097/QAD.0b013e3283262a78.en_US
dc.identifier.other10.1097/QAD.0b013e3283262a78.
dc.identifier.urihttps://nru.uncst.go.ug/xmlui/handle/123456789/1939
dc.language.isoenen_US
dc.publisherAIDS (London, England)en_US
dc.subjectHIV/AIDSen_US
dc.subjectAntiretroviral therapyen_US
dc.subjectImmunologic monitoringen_US
dc.titleFailure of immunologic criteria to appropriately identify antiretroviral treatment failure in Ugandaen_US
dc.typeArticleen_US
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