Factors associated with pre-treatment HIV RNA: application for the use of abacavir and rilpivirine as the first-line regimen for HIV-infected patients in resource-limited settingsReportar como inadecuado




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AIDS Research and Therapy

, 14:27

First Online: 05 May 2017Received: 15 January 2017Accepted: 26 April 2017DOI: 10.1186-s12981-017-0151-1

Cite this article as: Kiertiburanakul, S., Boettiger, D., Ng, O.T. et al. AIDS Res Ther 2017 14: 27. doi:10.1186-s12981-017-0151-1

Abstract

BackgroundAbacavir and rilpivirine are alternative antiretroviral drugs for treatment-naïve HIV-infected patients. However, both drugs are only recommended for the patients who have pre-treatment HIV RNA <100,000 copies-mL. In resource-limited settings, pre-treatment HIV RNA is not routinely performed and not widely available. The aims of this study are to determine factors associated with pre-treatment HIV RNA <100,000 copies-mL and to construct a model to predict this outcome.

MethodsHIV-infected adults enrolled in the TREAT Asia HIV Observational Database were eligible if they had an HIV RNA measurement documented at the time of ART initiation. The dataset was randomly split into a derivation data set 75% of patients and a validation data set 25%. Factors associated with pre-treatment HIV RNA <100,000 copies-mL were evaluated by logistic regression adjusted for study site. A prediction model and prediction scores were created.

ResultsA total of 2592 patients were enrolled for the analysis. Median interquartile range IQR age was 35.8 29.9–42.5 years; CD4 count was 147 50–248 cells-mm; and pre-treatment HIV RNA was 100,000 34,045–301,075 copies-mL. Factors associated with pre-treatment HIV RNA <100,000 copies-mL were age <30 years OR 1.40 vs. 41–50 years; 95% confidence interval CI 1.10–1.80, p = 0.01, body mass index >30 kg-m OR 2.4 vs. <18.5 kg-m; 95% CI 1.1–5.1, p = 0.02, anemia OR 1.70; 95% CI 1.40–2.10, p < 0.01, CD4 count >350 cells-mm OR 3.9 vs. <100 cells-mm; 95% CI 2.0–4.1, p < 0.01, total lymphocyte count >2000 cells-mm OR 1.7 vs. <1000 cells-mm; 95% CI 1.3–2.3, p < 0.01, and no prior AIDS-defining illness OR 1.8; 95% CI 1.5–2.3, p < 0.01. Receiver-operator characteristic ROC analysis yielded area under the curve of 0.70 95% CI 0.67–0.72 among derivation patients and 0.69 95% CI 0.65–0.74 among validation patients. A cut off score >25 yielded the sensitivity of 46.7%, specificity of 79.1%, positive predictive value of 67.7%, and negative predictive value of 61.2% for prediction of pre-treatment HIV RNA <100,000 copies-mL among derivation patients.

ConclusionA model prediction for pre-treatment HIV RNA <100,000 copies-mL produced an area under the ROC curve of 0.70. A larger sample size for prediction model development as well as for model validation is warranted.

KeywordsAbacavir HIV RNA Model Prediction Rilpivirine AbbreviationsARTantiretroviral therapy

HIVhuman immunodeficiency virus

ARVantiretroviral drugs

ABCabacavir

3TClamivudine

TDFtenofovir disoproxil fumarate

FTCemtricitabine

NNRTInon-nucleoside reverse transcriptase inhibitors

DTGdolutegravir

RPVrilpivirine

EFVefavirenz

TREATTherapeutics Research, Education, and AIDS Training

TAHODTREAT Asia HIV Observational Database

BMIbody mass index

RPRrapid plasma regain

VDRLVenereal Disease Research Laboratory

TPHATreponema pallidum particle agglutination assay

ORodds ratio

AUROCarea under the receiver-operator characteristic

IQRinterquartile range

CIconfidence interval

ATV-ratazanavir-ritonavir

RALraltegravir

DRV-rdarunavir-r

CPTclinical prediction tool

PPVpositive predictive value

NPVnegative predictive value





Autor: Sasisopin Kiertiburanakul - David Boettiger - Oon Tek Ng - Nguyen Van Kinh - Tuti Parwati Merati - Anchalee Avihingsanon

Fuente: https://link.springer.com/







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