Predicting Virological Failure with Immunological Criteria in First Line ART Patients in a Resource Poor Setting

Abstract

Indroduction: National Aids control Organisation in India implementing National AIDS control program uses WHO's immunological criteria to screen virological failure. Using immunological criteria to detect virological failure has to be assessed. Predicting virological failure with immunological criteria in resource limited settings had low sensitivity. Factors that influence the outcome are studied. Methods: Retrospective study in tertiary care centre for HIV and TB, Chennai, India. Out of 35,044 on ART between January 2008 and September 2009, 452 suspected immunological failures were referred. 273 screened for virological failure. Frequency, sensitivity/specificity, positive/negative predictive values, chi-square test, odds-ratio, independent sample t test for viral load greater than 10,000 and 1000 of each immunological criterion using Epi-Info and SPSS version 19. Results: 172 had virological failure (62.09%). Average age of failed was 37.33. Single criteria's sensitivity was 60 to 84 for detecting virolological failure. Two or more criteria had specificity 55 to 79. Combination of two or more criteria increased odds ratio for virological failure. Positive predictive value was above 63 for all criteria. PPV was above 80 to the criterion all three positive. Conclusions: ART naive patients with >95% adherence the sensitivity of immunological criteria to detect virological failure is three times than earlier studies. Combination of criteria is more significantly associated with virological failure. Odds ratio doubled for two or more combination of criteria. Immunological criteria is affordable/acceptable for screening virological failure, with adherence > 95% and longer the duration of ART.

Virological and immunological failure of HAART and associated risk factors among adults and adolescents in the Tigray region of Northern Ethiopia

“…Study participants with HIV RNA level ≥ 1000 copies/mL showed 12.33 times more likely to experience immunological failure (p <0.001) in a median time of 36 months of ART follow up as compared with those who have HIV RNA level less than 1000 copies/mL. Similar results have been reported from India [ 38 ], Nepal [ 33 ], Thailand [ 39 ], London [ 40 ], and USA [ 41 ].…”

“…Virological failure was 4.43 times more likely to happen in individuals aged less than 40 years old (AOR(95% CI) = 4.43(1.57–12.46), p = 0.005). This was supported by several studies conducted in Kenya [ 28 , 47 ], South Africa [ 59 ], Burkina Faso [ 44 ], Swaziland [ 55 ], result of systemic review in Sub Saharan Africa [ 26 ], India [ 38 ], Thailand [ 32 ] and Johns Hopkins-North Carolina University [ 60 ]. The possible explanation for this may be due to difference in maturity or lifestyle stability or may be due to work load and hence may forget to take medication properly.…”

“…Unlike to our result, higher virological failure was reported from Kenya 23.7% [ 45 ] and 24.6% [ 46 ], Liberia 47% [ 29 ], Zimbabwe 30.6% [ 47 ], Tanzania 57.1% [ 30 ], 32% [ 48 ], Cameroon 20.6% [ 49 ], Ghana 16.7% [ 50 ], Togo 51.6% [ 51 ], Colombia 20.9% [ 18 ], India 69.6% [ 38 ] and Peru 24% [ 52 ]. This difference may be due to lower treatment adherence compared with our study [ 48 , 52 ].…”

<p>Increased Virological Failure and Determinants Among HIV Patients on Highly Active Retroviral Therapy in Adigrat General Hospital, Northern Ethiopia, 2019: Hospital-Based Cross-Sectional Study</p>

“…The result of the current study was higher for virological failure than previously conducted research in Ethiopia (i.e., Jimma, 5.3% 50 and Gondar, 4.1% 51 ) and Burkina Faso at 7.5%. 52 However; our finding was lower than the other studies done in Cameron, 23.2% 53 and Kenya, 24%, 54 Liberia, 47%, 55 Zimbabwe, 30.6%, 56 Tanzania 57.1%, 57 32%, 58 Cameroon, 20.6%, 59 Ghana, 16.7%, 60 Togo, 51.6%, 61 Colombia, 20.9%, 62 India, 69.6% 63 and Peru, 24%. 64 This variance might be attributed due to differences in cutoff values of viral RNA copies per mL of plasma to be considered as virological failure, the difference among study participants, duration of follow-up, study design, and variations on the treatment adherence of HAART.…”

A Study of People Living With Hiv-Aids [Plha] on First Line Highly Active Antiretroviral Therapy [Haart] With Immunological Failure

“…(9) predicting virological failure with immunological failure showed 62% had virological failure, which was higher than this study. The sensitivity was higher ranging between 60 to 80% for each criterion, which was higher than the present study with positive predictive value was 20 to 91%.…”