Assessment of WHO criteria for identifying ART treatment failure in Vietnam from 2007 to 2011

Abstract

ObjectiveWe evaluated the sensitivity and specificity of the WHO immunological criteria for detecting antiretroviral therapy (ART) treatment failure in a cohort of Vietnamese patients. We conducted a stratified analysis to determine the effects of BMI, peer support, adherence to antiretroviral (ARV) drugs, age, and gender on the sensitivity and specificity of the WHO criteria.MethodsWe conducted a retrospective cohort study of 605 HIV-infected patients using data previously collected from a cluster randomized control trial study. We compared the sensitivity and specificity of CD4+ counts to the gold standard of virologic testing as a diagnostic test for ART failure at different time points of 12, 18, and 24 months.ResultsThe sensitivity [95% confidence interval (CI)] of the WHO immunological criteria based on a viral load ≥ 1000 copies/mL was 12% (5%-23%), 14% (2%-43%), and 12.5% (2%-38%) at 12, 18, and 24 months, respectively. In the same order, the specificity was 93% (90%-96%), 98% (96%-99%), and 98% (96%-100%). The positive predictive values (PPV) at 12, 18, and 24 months were 22% (9%-40%), 20% (3%-56%), and 29% (4%-71%); the negative predictive values (NPV) at the same time points were 87% (84%-90%), 97% (95%-98%), and 96% (93%-98%). The stratified analysis revealed similar sensitivities and specificities.ConclusionThe sensitivity of the WHO immunological criteria is poor, but the specificity is high. Although testing costs may increase, we recommend that Vietnam and other similar settings adopt viral load testing as the principal method for determining ART failure.

Feasibility of dried blood spots for HIV viral load monitoring in decentralized area in North Vietnam in a test-and-treat era, the MOVIDA project

“…This result follows the elevated HIV incidence in PWID in Vietnam [1] and is in line with previous findings [21,22]. Patients newly initiating ART were essentially men, a finding also highlighted in other studies in Vietnam [6,[23][24][25][26]. This is partly explained by the large representation of PWID in this study; nearly all PWID were male, as previously reported [27].…”

“…In 2017, it was estimated that about one third of those on ART received viral load testing in Vietnam [5]. This is particularly important as the immunological and clinical criteria to diagnose therapeutic failure have been shown to perform poorly [6][7][8]. Laboratories currently able to perform viral load measurements are concentrated in the large urban centers of Hanoi and Ho Chi Minh City, while HIV patients are spread all over the country.…”

Still poor HAART adherence has great impact on HIV/AIDS treatment failure in Ethiopia

“…Though it is found that the WHO immunological criteria have a very low sensitivity and high specificity (42), this finding showed that HIV treatment failure using immunological definition of treatment failure (10.2%) was higher than that of using clinical (6.3%) and virological (5.6%) definition of treatment failure. These variations might be due to the number of studies included to immunological definition of HIV treatment failure were many in number.…”

HIV/AIDS treatment failure and associated factors in Ethiopia: meta-analysis

“…Though the WHO immunological criterion is a very low sensitivity and high specificity test [40], this finding showed that HIV treatment failure was higher (10.2%) when the immunological definition used than that of clinical (6.3%) and virological (5.6%) treatment failure. This variation might be due to studies included in the immunological definition of HIV treatment failure were more than studies used to pool the clinical and virological failure.…”