Utility of CD4 cell counts for early prediction of virological failure during antiretroviral therapy in a resource-limited setting

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dc.contributor.authorBadri, Motasimen_ZA
dc.contributor.authorLawn, Stephen Den_ZA
dc.contributor.authorWood, Robinen_ZA
dc.date.accessioned2015-10-12T10:57:24Z
dc.date.available2015-10-12T10:57:24Z
dc.date.issued2008en_ZA
dc.description.abstractBACKGROUND:Viral load monitoring is not available for the vast majority of patients receiving antiretroviral therapy in resource-limited settings. However, the practical utility of CD4 cell count measurements as an alternative monitoring strategy has not been rigorously assessed. METHODS: In this study, we used a novel modelling approach that accounted for all CD4 cell count and VL values measured during follow-up from the first date that VL suppression was achieved. We determined the associations between CD4 counts (absolute values and changes during ART), VL measurements and risk of virological failure (VL > 1,000 copies/ml) following initial VL suppression in 330 patients in South Africa. CD4 count changes were modelled both as the difference from baseline (DeltaCD4 count) and the difference between consecutive values (CD4 count slope) using all 3-monthly CD4 count measurements during follow-up. RESULTS: During 7093.2 patient-months of observation 3756 paired CD4 count and VL measurements were made. In patients who developed virological failure (n = 179), VL correlated significantly with absolute CD4 counts (r = - 0.08, P = 0.003), DeltaCD4 counts (r = - 0.11, P < 0.01), and most strongly with CD4 count slopes (r = - 0.30, P < 0.001). However, the distributions of the absolute CD4 counts, DeltaCD4 counts and CD4 count slopes at the time of virological failure did not differ significantly from the corresponding distributions in those without virological failure (P = 0.99, P = 0.92 and P = 0.75, respectively). Moreover, in a receiver operating characteristic (ROC) curve, the association between a negative CD4 count slope and virological failure was poor (area under the curve = 0.59; sensitivity = 53.0%; specificity = 63.6%; positive predictive value = 10.9%). CONCLUSION: CD4 count changes correlated significantly with VL at group level but had very limited utility in identifying virological failure in individual patients. CD4 count is an inadequate alternative to VL measurement for early detection of virological failure.en_ZA
dc.identifier.apacitationBadri, M., Lawn, S. D., & Wood, R. (2008). Utility of CD4 cell counts for early prediction of virological failure during antiretroviral therapy in a resource-limited setting. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/14190en_ZA
dc.identifier.chicagocitationBadri, Motasim, Stephen D Lawn, and Robin Wood "Utility of CD4 cell counts for early prediction of virological failure during antiretroviral therapy in a resource-limited setting." <i>BMC Infectious Diseases</i> (2008) http://hdl.handle.net/11427/14190en_ZA
dc.identifier.citationBadri, M., Lawn, S. D., & Wood, R. (2008). Utility of CD4 cell counts for early prediction of virological failure during antiretroviral therapy in a resource-limited setting. BMC infectious diseases, 8(1), 89.en_ZA
dc.identifier.ris TY - Journal Article AU - Badri, Motasim AU - Lawn, Stephen D AU - Wood, Robin AB - BACKGROUND:Viral load monitoring is not available for the vast majority of patients receiving antiretroviral therapy in resource-limited settings. However, the practical utility of CD4 cell count measurements as an alternative monitoring strategy has not been rigorously assessed. METHODS: In this study, we used a novel modelling approach that accounted for all CD4 cell count and VL values measured during follow-up from the first date that VL suppression was achieved. We determined the associations between CD4 counts (absolute values and changes during ART), VL measurements and risk of virological failure (VL > 1,000 copies/ml) following initial VL suppression in 330 patients in South Africa. CD4 count changes were modelled both as the difference from baseline (DeltaCD4 count) and the difference between consecutive values (CD4 count slope) using all 3-monthly CD4 count measurements during follow-up. RESULTS: During 7093.2 patient-months of observation 3756 paired CD4 count and VL measurements were made. In patients who developed virological failure (n = 179), VL correlated significantly with absolute CD4 counts (r = - 0.08, P = 0.003), DeltaCD4 counts (r = - 0.11, P < 0.01), and most strongly with CD4 count slopes (r = - 0.30, P < 0.001). However, the distributions of the absolute CD4 counts, DeltaCD4 counts and CD4 count slopes at the time of virological failure did not differ significantly from the corresponding distributions in those without virological failure (P = 0.99, P = 0.92 and P = 0.75, respectively). Moreover, in a receiver operating characteristic (ROC) curve, the association between a negative CD4 count slope and virological failure was poor (area under the curve = 0.59; sensitivity = 53.0%; specificity = 63.6%; positive predictive value = 10.9%). CONCLUSION: CD4 count changes correlated significantly with VL at group level but had very limited utility in identifying virological failure in individual patients. CD4 count is an inadequate alternative to VL measurement for early detection of virological failure. DA - 2008 DB - OpenUCT DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2008 T1 - Utility of CD4 cell counts for early prediction of virological failure during antiretroviral therapy in a resource-limited setting TI - Utility of CD4 cell counts for early prediction of virological failure during antiretroviral therapy in a resource-limited setting UR - http://hdl.handle.net/11427/14190 ER - en_ZA
dc.identifier.uri10.1186/1471-2334-8-89en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14190
dc.identifier.vancouvercitationBadri M, Lawn SD, Wood R. Utility of CD4 cell counts for early prediction of virological failure during antiretroviral therapy in a resource-limited setting. BMC Infectious Diseases. 2008; http://hdl.handle.net/11427/14190.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Infectious Diseasesen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcinfectdis/en_ZA
dc.subject.otherVirologyen_ZA
dc.titleUtility of CD4 cell counts for early prediction of virological failure during antiretroviral therapy in a resource-limited settingen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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