Predicting virological decay in patients starting combination antiretroviral therapy.

TitlePredicting virological decay in patients starting combination antiretroviral therapy.
Publication TypeJournal Article
Year of Publication2016
Corporate AuthorsUK Collaborative HIV Cohort(UK CHIC) Writing Committee
JournalAIDS
Volume30
Issue11
Pagination1817-27
Date Published2016 Jul 17
ISSN1473-5571
Abstract

OBJECTIVE: Model trajectories of viral load measurements from time of starting combination antiretroviral therapy (cART), and use the model to predict whether patients will achieve suppressed viral load (≤200 copies/ml) within 6-months of starting cART.DESIGN: Prospective cohort study including HIV-positive adults (UK Collaborative HIV Cohort Study).METHODS: Eligible patients were antiretroviral naive and started cART after 1997. Random effects models were used to estimate viral load trends. Patients were randomly selected to form a validation dataset with those remaining used to fit the model. We evaluated predictions of suppression using indices of diagnostic test performance.RESULTS: Of 9562 eligible patients 6435 were used to fit the model and 3127 for validation. Mean log10 viral load trajectories declined rapidly during the first 2 weeks post-cART, moderately between 2 weeks and 3 months, and more slowly thereafter. Higher pretreatment viral load predicted steeper declines, whereas older age, white ethnicity, and boosted protease inhibitor/non-nucleoside reverse transcriptase inhibitors based cART-regimen predicted a steeper decline from 3 months onwards. Specificity of predictions and the diagnostic odds ratio substantially improved when predictions were based on viral load measurements up to the 4-month visit compared with the 2 or 3-month visits. Diagnostic performance improved when suppression was defined by two consecutive suppressed viral loads compared with one.CONCLUSIONS: Viral load measurements can be used to predict if a patient will be suppressed by 6-month post-cART. Graphical presentations of this information could help clinicians decide the optimum time to switch treatment regimen during the first months of cART.

DOI10.1097/QAD.0000000000001125
Alternate JournalAIDS
PubMed ID27124894
PubMed Central IDPMC4933580
Grant ListG0600337 / / Medical Research Council / United Kingdom
G0900274 / / Medical Research Council / United Kingdom
MR/J013773/1 / / Medical Research Council / United Kingdom
MR/M004236/1 / / Medical Research Council / United Kingdom