Defining treatment failure in resource-rich settings

Aldous, Jeannette L.; Haubrich, Richard

doi:10.1097/coh.0b013e328331dea5

Cited by 43 publications

(45 citation statements)

References 52 publications

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“…Our definition of viremia was based on a single prescan HIV plasma RNA measurement of >200 copies/mL as per the latest US Department of Health and Human Services guidelines [18, 19]. …”

Section: Methodsmentioning

confidence: 99%

Differentiation of HIV-associated lymphoma from HIV-associated reactive adenopathy using quantitative FDG PET and symmetry

Mhlanga

Durand

Tsai

et al. 2014

Eur J Nucl Med Mol Imaging

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Purpose To determine the diagnostic accuracy of a semiautomated 18F-FDG PET/CT measurement of total lesion glycolysis (TLG), maximum and peak standardized uptake value at lean body mass (SUL-Max and SUL-Peak), qualitative estimates of left/right nodal symmetry and FDG uptake for differentiating lymphoma from reactive adenopathy in HIV-infected patients. Methods We retrospectively analyzed 41 whole-body 18F-FDG PET/CT studies performed in HIV-infected patients for clinical reasons. The study received institutional review board approval. Of the 41 patients, 19 had biopsy-proven untreated lymphoma, and 22 with reactive adenopathy without malignancy on follow-up were used as controls. Nodal and extranodal visual qualitative metabolic scores, SUL-Max, SUL-Peak, CT nodal size, and PERCIST 1.0 threshold-based TLG and metabolic tumor volume (MTV) were determined. The qualitative intensity of nodal involvement and symmetry of uptake were compared using receiver operator curve (ROC) analysis. HIV plasma viral RNA measurements were also obtained. Results All of the quantitative PET metrics performed well in differentiating lymphoma from reactive adenopathy and performed better than qualitative visual intensity scores. The areas under the ROC curves (AUC) were significantly higher for TLG=0.96, single SUL-Peak=0.96, single SUL-Max=0.97, and MTV=0.96, compared to 0.67 for CT nodal size (p<0.001). These PET metrics performed best in separating the two populations in aviremic patients, with AUCs of 1 (AUC 0.91 for CT nodal size). TLG, MTV, SUL-Peak and SUL-Max were more reliable markers among viremic individuals, with AUCs between 0.84 and 0.93, compared to other metrics. PET metrics were significantly correlated with plasma viral load in HIV-reactive adenopathy controls. Asymmetrical FDG uptake had an accuracy of 90.4 % for differentiating lymphoma from reactive adenopathy in HIV-infected patients. Conclusion Quantitative PET metabolic metrics as well as the qualitative assessment of symmetry of nodal uptake appear to be valuable tools for differentiating lymphoma from reactive adenopathy in HIV-infected patients using FDG PET. These parameters appear more robust in aviremic patients.

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“…Our definition of viremia was based on a single prescan HIV plasma RNA measurement of >200 copies/mL as per the latest US Department of Health and Human Services guidelines [18, 19]. …”

Section: Methodsmentioning

confidence: 99%

Differentiation of HIV-associated lymphoma from HIV-associated reactive adenopathy using quantitative FDG PET and symmetry

Mhlanga

Durand

Tsai

et al. 2014

Eur J Nucl Med Mol Imaging

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“…Those around the current limit of detection of 50 copies/ml and that occur only once may not be predictors of future failure 45 copies/ml, will be deleterious. A previous study suggested a significant increase in risk of virological failure in patients whose EIV is over 120 copies/ml.…”

Section: Discussionmentioning

confidence: 99%

Influence of Episodes of Intermittent Viremia (“Blips”) on Immune Responses and Viral Load Rebound in Successfully Treated HIV-Infected Patients

Castro

Plana

González

et al. 2013

AIDS Research and Human Retroviruses

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“…[12] Immunological criteria were two times more sensitive than clinical criteria in the current and previous studies, supporting the concept that immunological failure occurs earlier than clinical failure. [13] When a combination of clinical and immunological criteria was used, the sensitivity and specificity to predict virological failure were 25.8% and 69.9%, respectively. The combination of clinical and immunological criteria therefore had higher sensitivity but relatively low specificity in predicting virological failure, i.e.…”

Section: Discussionmentioning

confidence: 99%

Detecting virological failure in HIV-infected Tanzanian children

2014

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Background. The performance of clinical and immunological criteria to predict virological failure in HIV-infected children receiving antiretroviral therapy (ART) is not well documented. Objective. To determine the validity of clinical and immunological monitoring in detecting virological failure in children on ART. Methods. A total of 218 children were included in the study. All were from care and treatment clinics in Dar es Salaam, Tanzania. Their mean age was 10.6 years, 122 (56.0%) were males, and the mean time on ART was 40.9 months. The study was conducted from August 2011 to March 2012. Data on sociodemographic and clinical characteristics and immunological and virological failure were based on World Health Organization definitions. Blood samples were collected for CD4 + T-cell count and viral load tests. Results. Of 217 children with available viral load results, 124 (57.1%) had virological failure (>400 copies/mL), 25.0% immunological failure and 11.5% clinical failure. The sensitivity, specificity, positive predictive value and negative predictive value of clinical criteria were 12.9%, 90.3%, 64.0% and 43.8%, respectively, those for immunological criteria 22.6%, 73.1%, 53.3% and 41.4%, and those for the combination of clinical and immunological monitoring 25.8%, 69.9%, 53.3% and 41.4%. Children who received nevirapine (NVP)-based regimens were two times more likely (odds ratio 2.0; 95% confidence interval 1.20 -3.64) to have virological failure than those on efavirenz and protease inhibitor-based regimens. Conclusions. The study demonstrated poor performance of currently recommended clinical and immunological criteria for monitoring HIV-infected children on ART. Moreover, children on NVP-based regimens had a higher risk of developing virological failure than those on other regimens.

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Defining treatment failure in resource-rich settings

Cited by 43 publications

References 52 publications

Differentiation of HIV-associated lymphoma from HIV-associated reactive adenopathy using quantitative FDG PET and symmetry

Differentiation of HIV-associated lymphoma from HIV-associated reactive adenopathy using quantitative FDG PET and symmetry

Influence of Episodes of Intermittent Viremia (“Blips”) on Immune Responses and Viral Load Rebound in Successfully Treated HIV-Infected Patients

Detecting virological failure in HIV-infected Tanzanian children

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