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Predicting virological decay in patients starting combination antiretroviral therapy.

- AIDS (2016)

Bottom Line: Eligible patients were antiretroviral naive and started cART after 1997.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.

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus

Prediction graphs of four selected patients based on observations measured before 3-month visit (left-hand column) and on observations measured after 3-month visit (right-hand column).
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Figure 3: Prediction graphs of four selected patients based on observations measured before 3-month visit (left-hand column) and on observations measured after 3-month visit (right-hand column).

Mentions: Figure 3 compares observed with predicted future viral load measurements before and after the 3-month visit, for patients who were selected to illustrate a range of viral load patterns and predictions. The shaded areas denote 95% prediction intervals for each patient. Because patients had a small number of observed measurements the prediction intervals were wide.


Predicting virological decay in patients starting combination antiretroviral therapy.

- AIDS (2016)

Prediction graphs of four selected patients based on observations measured before 3-month visit (left-hand column) and on observations measured after 3-month visit (right-hand column).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4933580&req=5

Figure 3: Prediction graphs of four selected patients based on observations measured before 3-month visit (left-hand column) and on observations measured after 3-month visit (right-hand column).
Mentions: Figure 3 compares observed with predicted future viral load measurements before and after the 3-month visit, for patients who were selected to illustrate a range of viral load patterns and predictions. The shaded areas denote 95% prediction intervals for each patient. Because patients had a small number of observed measurements the prediction intervals were wide.

Bottom Line: Eligible patients were antiretroviral naive and started cART after 1997.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.

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus