1 / 8

Snigdha Vallabhaneni 1 , Sara Chandy 2 , Elsa Heylen 1 , Maria Ekstrand 1,2

Evaluation of the WHO immunologic criteria for treatment failure among adults on first-line HAART in south India. Snigdha Vallabhaneni 1 , Sara Chandy 2 , Elsa Heylen 1 , Maria Ekstrand 1,2

lev
Download Presentation

Snigdha Vallabhaneni 1 , Sara Chandy 2 , Elsa Heylen 1 , Maria Ekstrand 1,2

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Evaluation of the WHO immunologic criteria for treatment failure among adults on first-line HAART in south India Snigdha Vallabhaneni1, Sara Chandy2, Elsa Heylen1, Maria Ekstrand1,2 Center for AIDS Prevention Studies, University of California, San Francisco, USA(2) St John’s National Academy of Health Sciences, Bangalore, India

  2. Objectives • Evaluate the test performance characteristics of WHO criteria for immunologic failure (IF), compared against virologic failure (VF) in the Indian setting. • Assess the genotypic consequences of staying on a failing regimen. Methods • Longitudinal cohort study (2007-2011) in Bangalore, India • 522 HIV+ participants on HAART for at least 6 months. • CD4, VL, and genotype every 6 months for 24 months. • IF = fall of CD4 to pre-tx baseline, ≥50% fall from peak, persistently <100 cells/mm3. • VF = 2 VL ≥ 1000 copies/ml or 1VL ≥ 10,000 copies/ml.

  3. Genotypic consequence of staying on a failing regimen (N=44) Results Test Characteristics of WHO-IF criteria to detect VF Sensitivity: 22.8% (95% CI: 12.7-35.8) Specificity: 93.8% (95% CI: 91.2-95.8) PPV: 31.0% 95%CI: 17.6-47.1

  4. Genotypic consequence of staying on a failing regimen (N=44) Results Test Characteristics of WHO-IF criteria to detect VF Sensitivity: 22.8% (95% CI: 12.7-35.8) Specificity: 93.8% (95% CI: 91.2-95.8) PPV: 31.0% 95%CI: 17.6-47.1

  5. Genotypic consequence of staying on a failing regimen (N=44) Results Test Characteristics of WHO-IF criteria to detect VF Sensitivity: 22.8% (95% CI: 12.7-35.8) Specificity: 93.8% (95% CI: 91.2-95.8) PPV: 31.0% 95%CI: 17.6-47.1

  6. Genotypic consequence of staying on a failing regimen (N=44) Results Test Characteristics of WHO-IF criteria to detect VF Sensitivity: 22.8% (95% CI: 12.7-35.8) Specificity: 93.8% (95% CI: 91.2-95.8) PPV: 31.0% 95%CI: 17.6-47.1

  7. Genotypic consequence of staying on a failing regimen (N=44) Results Test Characteristics of WHO-IF criteria to detect VF Sensitivity: 22.8% (95% CI: 12.7-35.8) Specificity: 93.8% (95% CI: 91.2-95.8) PPV: 31.0% 95%CI: 17.6-47.1

  8. Conclusions • WHO criteria for immunologic failure have poor sensitivity (22.8%) for detecting virologic failure. By using these criteria, a notable proportion of patients would be continued on first line therapy that they are already failing. • Implications for second line therapy: at 18 months of f/u, • 35% patients had predicted resistance tenofovir • 65% patients had predicted resistance to etravirine. • Given the poor PPV (31%), relying on CD4 count data alone would lead to a substantial number of unnecessary switches to second-line HAART. • Universal access to VL monitoring would avoid costly switches to second-line HAART and preserve future therapeutic options.

More Related