TITLE:
Predicting Virological Failure with Immunological Criteria in First Line ART Patients in a Resource Poor Setting
AUTHORS:
Krishnaraj Raja, Chockalingam Chandrasekar, O. R. Krishnarajasekhar, Narayanan Ravichandran, Satagopan Kumar, Gurusamy Manoharan, Irudayaraj Amala Sharmila
KEYWORDS:
ART, Immunological Failure, Virological Failue, Immunological Criteria, Resource Limited Settings
JOURNAL NAME:
World Journal of AIDS,
Vol.4 No.4,
December
4,
2014
ABSTRACT: Indroduction: National Aids control
Organisation in India implementing National AIDS controlprogram 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.