The role of targeted viral load testing in diagnosing virological failure in children on antiretroviral therapy with immunological failure

Objectives To determine the improvement in positive predictive value of immunological failure criteria for identifying virological failure in HIV‐infected children on antiretroviral therapy (ART) when a single targeted viral load measurement is performed in children identified as having immunological failure. Methods Analysis of data from children (<16 years at ART initiation) at South African ART sites at which CD4 count/per cent and HIV‐RNA monitoring are performed 6‐monthly. Immunological failure was defined according to both WHO 2010 and United States Department of Health and Human Services (DHHS) 2008 criteria. Confirmed virological failure was defined as HIV‐RNA >5000 copies/ml on two consecutive occasions <365 days apart in a child on ART for ≥18 months. Results Among 2798 children on ART for ≥18 months [median (IQR) age 50 (21–84) months at ART initiation], the cumulative probability of confirmed virological failure by 42 months on ART was 6.3%. Using targeted viral load after meeting DHHS immunological failure criteria rather than DHHS immunological failure criteria alone increased positive predictive value from 28% to 82%. Targeted viral load improved the positive predictive value of WHO 2010 criteria for identifying confirmed virological failure from 49% to 82%. Conclusion The addition of a single viral load measurement in children identified as failing immunologically will prevent most switches to second‐line treatment in virologically suppressed children.     

Determinants of unplanned antiretroviral treatment interruptions among people living with HIV in Yaoundé, Cameroon (EVAL survey,ANRS 12‐116)

Objective To identify correlates of self‐reported antiretroviral therapies (ART) interruptions among people living with HIV and AIDS (PLWHA) in Cameroon. Methods Analyses were based on data collected in the national survey EVAL (ANRS 12‐116) among 533 ART‐treated PLWHA in Yaoundé, the capital city of Cameroon, and its neighbourhood. Logistic regression models were used to identify factors associated with self‐reported ART interruptions longer than two consecutive days during the previous 4 weeks. Results ART interruptions were reported by 68 patients (12.8%). After adjustment for gender, education and household income, characteristics independently associated with interruptions were pharmacy stock shortages [OR (95%CI):3.25 (1.78–5.90)], binge drinking [2.87 (1.39–5.91)] and the number of self‐reported slimming symptoms [1.23 (1.02–1.48)]. Conclusion In poor‐resource settings where access to second and third‐line regimens is still limited, food supply programs and interventions to minimise ART shortage may reduce the risk of ART interruptions.     

Total lymphocyte count is a reliable surrogate marker for CD4 cell counts after the first year of antiretroviral therapy: data from an Indonesian cohort study

Many studies have evaluated the total lymphocyte count (TLC) as a cheap surrogate marker for CD4 cells in HIV‐infected patients not receiving antiretroviral therapy (ART). We assessed whether TLC can replace CD4 cell counts in evaluating the immunological response to ART. In a cohort of patients in Indonesia TLC, if measured after at least 1‐year ART, correctly identified patients with <200 CD4 cells, and reliably excluded immunological failure, obviating the need for CD4 cell measurement in 43% of patients.