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Predicting virological decay in patients starting combination antiretroviral therapy

Hughes, RA; Sterne, JAC; Walsh, J; Post, F; Nelson, M; Jose, S; Hill, T; ... Sabin, CA; + view all (2016) Predicting virological decay in patients starting combination antiretroviral therapy. AIDS , 30 (11) pp. 1817-1827. 10.1097/QAD.0000000000001125. Green open access

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Abstract

Objective: Model trajectories of viral load measurements from time of starting combination antiretroviral therapy (cART), and use the model to predict whether patients will achieve suppressed viral load (<=200 copies/ml) within 6-months of starting cART. Design: Prospective cohort study including HIV-positive adults (UK Collaborative HIV Cohort Study). Methods: Eligible patients were antiretroviral naive and started cART after 1997. Random effects models were used to estimate viral load trends. Patients were randomly selected to form a validation dataset with those remaining used to fit the model. We evaluated predictions of suppression using indices of diagnostic test performance. Results: Of 9562 eligible patients 6435 were used to fit the model and 3127 for validation. Mean log10 viral load trajectories declined rapidly during the first 2 weeks post-cART, moderately between 2 weeks and 3 months, and more slowly thereafter. Higher pretreatment viral load predicted steeper declines, whereas older age, white ethnicity, and boosted protease inhibitor/non-nucleoside reverse transcriptase inhibitors based cART-regimen predicted a steeper decline from 3 months onwards. Specificity of predictions and the diagnostic odds ratio substantially improved when predictions were based on viral load measurements up to the 4-month visit compared with the 2 or 3-month visits. Diagnostic performance improved when suppression was defined by two consecutive suppressed viral loads compared with one. Conclusions: Viral load measurements can be used to predict if a patient will be suppressed by 6-month post-cART. Graphical presentations of this information could help clinicians decide the optimum time to switch treatment regimen during the first months of cART.

Type: Article
Title: Predicting virological decay in patients starting combination antiretroviral therapy
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAD.0000000000001125
Publisher version: http://dx.doi.org/10.1097/QAD.0000000000001125
Additional information: This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
Keywords: Science & Technology, Life Sciences & Biomedicine, Immunology, Infectious Diseases, Virology, CD4(+) cell count, combination antiretroviral therapy, HIV-1, predicted virological suppression, treatment switch, viral load, HIV-1 RNA DYNAMICS, BASE-LINE FACTORS, VIRAL DYNAMICS, PROSTATE-CANCER, EQUAL ACCESS, IN-VIVO, RESPONSES, INFECTION, COHORT, LOAD
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1513377
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