Predictive Factors of Detectable Viral Load in HIV-Infected Patients

Bouchard, Audrey; Bourdeau, François; Roger, Julien; Taillefer, Vincent-Thierry; Sheehan, Nancy L.; Schnitzer, Mireille E.; Wang, Guanbo; Baptiste, Imma Judy Jean; Therrien, Rachel

doi:10.1089/aid.2021.0106

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…For instance, one could relax the assumption that the hazard is dependent on the current value of the covariates, assume event times follow a parametric distribution by using accelerated failure time models, 67 generalize to different penalty types (for example, minimax concave penalty, 68 or smoothly clipped absolute deviation 69 ), and investigate the impact of applying different weighting schemes. In addition, it would be beneficial to integrate structured variable selection into causal inference, especially when the confounders or effect modifiers are high‐dimensional 70‐79 …”

Section: Discussionmentioning

confidence: 99%

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Structured learning in time‐dependent Cox models

Wang,

Lian,

Yang

et al. 2024

Statistics in Medicine

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Cox models with time‐dependent coefficients and covariates are widely used in survival analysis. In high‐dimensional settings, sparse regularization techniques are employed for variable selection, but existing methods for time‐dependent Cox models lack flexibility in enforcing specific sparsity patterns (ie, covariate structures). We propose a flexible framework for variable selection in time‐dependent Cox models, accommodating complex selection rules. Our method can adapt to arbitrary grouping structures, including interaction selection, temporal, spatial, tree, and directed acyclic graph structures. It achieves accurate estimation with low false alarm rates. We develop the sox package, implementing a network flow algorithm for efficiently solving models with complex covariate structures. sox offers a user‐friendly interface for specifying grouping structures and delivers fast computation. Through examples, including a case study on identifying predictors of time to all‐cause death in atrial fibrillation patients, we demonstrate the practical application of our method with specific selection rules.

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Section: Discussionmentioning

confidence: 99%

“…In addition, it would be beneficial to integrate structured variable selection into causal inference, especially when the confounders or effect modifiers are high-dimensional. [70][71][72][73][74][75][76][77][78][79]…”

Section: Covariatementioning

confidence: 99%

Structured learning in time‐dependent Cox models

Wang,

Lian,

Yang

et al. 2024

Statistics in Medicine

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Managing low-level HIV viraemia in antiretroviral therapy: a systematic review and meta-analysis

Zaçe,

Rindi,

Compagno

et al. 2024

Sex Transm Infect

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ObjectiveHIV-1 management has advanced significantly with antiretroviral therapy (ART), yet challenges persist, including low-level HIV-1 viraemia (LLV). LLV presents a complex scenario, with varied definitions in the literature, reflecting uncertainties in its clinical interpretation. Questions arise regarding the underlying mechanisms of LLV, whether it signifies ongoing viral replication or stems from other factors. This study aimed to systematically review strategies for LLV management, providing insights into optimal clinical approaches.MethodsMEDLINE, EMBASE, Cochrane Library, Web of Science and Canadian Agency for Drugs and Technologies in Health were searched for relevant literature on LLV management. We included studies published between 2004 and 2024, assessing interventions such as ART modification, genotypic resistance testing, adherence assessment, performing therapeutic drug monitoring, testing for chronic coinfections and assessing the viral reservoir via HIV DNA quantification. Meta-analyses were conducted where feasible.ResultsThe systematic review identified 48 eligible records. Findings indicated limited evidence supporting the effectiveness of ART regimen modification in achieving virological suppression among individuals with LLV. However, studies assessing genotypic resistance testing revealed a significant association between resistance-associated mutations and virological suppression during LLV. Adherence to ART emerged as a critical determinant of treatment efficacy, with interventions showing promise in achieving viral suppression. The clinical utility of therapeutic drug monitoring in managing LLV remained inconclusive. Gaps in the literature were identified regarding follow-up scheduling, managing concurrent chronic infections and assessing inflammatory markers in LLV management.ConclusionsWhile ART modification may not consistently achieve virological suppression, genotypic resistance testing may offer insights into treatment outcomes. Adherence to ART emerged as a crucial factor, necessitating tailored interventions. However, further research is needed to elucidate the clinical utility of therapeutic drug monitoring and other management strategies. The study highlights the importance of ongoing research to refine therapeutic approaches and improve patient outcomes in LLV management.PROSPERO registration numberCRD42024511492.

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Management of low-level HIV viremia during antiretroviral therapy: Delphi consensus statement and appraisal of the evidence

Rindi,

Zaçe,

Compagno

et al. 2024

Sex Transm Infect

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ObjectiveWhile antiretroviral therapy (ART) is highly effective, detection of low levels of HIV-1 RNA in plasma is common in treated individuals. Given the uncertainties on the topic, we convened a panel of experts to consider different clinical scenarios, producing a Delphi consensus to help guide clinical practice.MethodsA panel of 17 experts in infectious diseases, virology and immunology rated 32 statements related to four distinct scenarios: (1) low-level viremia during stable (≥6 months) first-line ART (≥2 consecutive HIV-1 RNA measurements 50–500 copies/mL); (2) a viral blip during otherwise suppressive ART (a HIV-1 RNA measurement 50–1000 copies/mL with adjacent measurements <50 copies/mL); (3) low-level viral rebound during previously suppressive ART (≥2 consecutive HIV-1 RNA measurements 50–500 copies/mL); (4) residual viremia during suppressive ART (persistent HIV-1 RNA quantification below 50 copies/mL). A systematic review, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement, informed the 32 statements. The Delphi procedure was modified to include two voting rounds separated by a moderated group discussion. Grading of Recommendations, Assessment, Development, and Evaluations-based recommendations were developed.ResultsOverall, 18/32 statements (56.2%) achieved a strong consensus, 3/32 (9.4%) achieved a moderate consensus and 11/32 (34.4%) did not achieve a consensus. Across the four scenarios, the panel unanimously emphasised the importance of implementing specific interventions prior to considering therapy changes, including assessing adherence, testing for genotypic drug resistance and scheduling more frequent follow-up visits. Strategies indicated in selected circumstances included therapeutic drug monitoring, quantifying total HIV-1 DNA and evaluating concomitant chronic infections.ConclusionsWhile acknowledging the many uncertainties about source, significance and optimal management of low-level viremia during ART, the findings provide insights to help harmonise clinical practice. There is a need for well-designed randomised studies assessing different interventions to manage low-level viremia and future research regarding its definition.

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Predictive Factors of Detectable Viral Load in HIV-Infected Patients

Cited by 3 publications

References 22 publications

Structured learning in time‐dependent Cox models

Structured learning in time‐dependent Cox models

Managing low-level HIV viraemia in antiretroviral therapy: a systematic review and meta-analysis

Management of low-level HIV viremia during antiretroviral therapy: Delphi consensus statement and appraisal of the evidence

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