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Associations between HIV-RNA-based indicators and virological and clinical outcomes

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Titel: Associations between HIV-RNA-based indicators and virological and clinical outcomes
Autoren: Laut, Kamilla G., Shepherd, Leah C., Pedersen, Court, Rockstroh, Jürgen K., Sambatakou, Helen, Paduta, Dimitry, Matulionyte, Raimonda, Smiatacz, Tomasz, Mulcahy, Fiona, Lundgren, Jens D., Mocroft, Amanda, Kirk, Ole, Gatell, J., Gazzard, B., Horban, A., Karpov, I., Ledergerber, B., Losso, M., Monforte, A. D arminio, Rakhmanova, A., Ristola, M., Phillips, A., Reiss, P., Lundgren, J., Rockstroh, J., De Wit, S., Kirk, O., Mocroft, A., Grarup, J., Cozzi-Lepri, A., Thiebaut, R., Burger, D., Paredes, R., Peters, L.
Quelle: Laut, K G, Shepherd, L C, Pedersen, C, Rockstroh, J K, Sambatakou, H, Paduta, D, Matulionyte, R, Smiatacz, T, Mulcahy, F, Lundgren, J D, Mocroft, A, Kirk, O, Gatell, J, Gazzard, B, Horban, A, Karpov, I, Ledergerber, B, Losso, M, Monforte, A D A, Rakhmanova, A, Ristola, M, Phillips, A, Reiss, P, Lundgren, J, Rockstroh, J, De Wit, S, Rockstroh, J, De Wit, S, Kirk, O, Mocroft, A, Grarup, J, Reiss, P, Cozzi-Lepri, A, Thiebaut, R, Rockstroh, J, Burger, D, Paredes, R & Peters, L 2016, ' Associations between HIV-RNA-based indicators and virological and clinical outcomes ', AIDS, vol. 30, no. 12, pp. 1961-1972 . https://doi.org/10.1097/QAD.0000000000001144
Verlagsinformationen: Ovid Technologies (Wolters Kluwer Health), 2016.
Publikationsjahr: 2016
Schlagwörter: Adult, Male, HIV Infections, Viral/blood, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Journal Article, Health Status Indicators, Humans, RNA, Viral/blood, benchmarking, outcome assessment (healthcare), HIV, quality indicators, Middle Aged, Viral Load, Survival Analysis, viral load, 3. Good health, AIDS, HIV Infections/diagnosis, Treatment Outcome, RNA, RNA, Viral, Female, Drug Monitoring, Drug Monitoring/methods
Beschreibung: To evaluate and compare the performance of six HIV-RNA-based quality of care indicators for predicting short-term and long-term outcomes.Multinational cohort study.We included EuroSIDA patients on antiretroviral therapy (ART) with at least three viral load measurements after baseline (the latest of 01/01/2001 or entry into EuroSIDA). Using multivariate Poisson regression, we modelled the association between short-term (resistance, triple-class failure) and long-term (all-cause mortality, any AIDS/non-AIDS clinical event) outcomes and the indicators: viraemia copy years; consecutive months with viral load ≥ 50 copies/ml; percentage of time on ART spent fully suppressed (%FS); stable on ART; 48 weeks snapshot; and current viral load. Indicators were compared using area under the ROC curve (AUC) and different measures of model fit.Adjusted incidence rate ratios for all outcomes tended to increase with increasing viraemia copy years, number of consecutive months with viral load ≥ 50 copies/ml, current viral load and with lower %FS, but the gradient of increased risk was weak across strata. None of the indicators reliably identified those at risk of long-term outcomes (AUC 0.54-0.58), but performed consistently better with short-term outcomes [triple class failure (AUC 0.67-0.76) and resistance (AUC 0.64-0.79)]. Goodness of fit varied with the outcome evaluated, but differences between indicators were small.Differences between quality of care indicators were small and no indicator performed consistently better than current viral load. Given the simplicity in assessing and interpreting this indicator, we propose to use current viral load when HIV-RNA-based indicators are used to evaluate the efficacy of ART programs.
Publikationsart: Article
Sprache: English
ISSN: 0269-9370
DOI: 10.1097/qad.0000000000001144
Zugangs-URL: https://discovery.ucl.ac.uk/1494652/1/Mocroft_00002030-900000000-97775.pdf
https://pubmed.ncbi.nlm.nih.gov/27149091
https://pubmed.ncbi.nlm.nih.gov/27149091/
https://moh-it.pure.elsevier.com/en/publications/associations-between-hiv-rna-based-indicators-and-virological-and
https://discovery.ucl.ac.uk/id/eprint/1494652
http://www.scopus.com/inward/record.url?scp=84965017129&partnerID=8YFLogxK
Dokumentencode: edsair.doi.dedup.....4d19c58500bc0143d227ebdd90f9246d
Datenbank: OpenAIRE
Beschreibung
Abstract:To evaluate and compare the performance of six HIV-RNA-based quality of care indicators for predicting short-term and long-term outcomes.Multinational cohort study.We included EuroSIDA patients on antiretroviral therapy (ART) with at least three viral load measurements after baseline (the latest of 01/01/2001 or entry into EuroSIDA). Using multivariate Poisson regression, we modelled the association between short-term (resistance, triple-class failure) and long-term (all-cause mortality, any AIDS/non-AIDS clinical event) outcomes and the indicators: viraemia copy years; consecutive months with viral load ≥ 50 copies/ml; percentage of time on ART spent fully suppressed (%FS); stable on ART; 48 weeks snapshot; and current viral load. Indicators were compared using area under the ROC curve (AUC) and different measures of model fit.Adjusted incidence rate ratios for all outcomes tended to increase with increasing viraemia copy years, number of consecutive months with viral load ≥ 50 copies/ml, current viral load and with lower %FS, but the gradient of increased risk was weak across strata. None of the indicators reliably identified those at risk of long-term outcomes (AUC 0.54-0.58), but performed consistently better with short-term outcomes [triple class failure (AUC 0.67-0.76) and resistance (AUC 0.64-0.79)]. Goodness of fit varied with the outcome evaluated, but differences between indicators were small.Differences between quality of care indicators were small and no indicator performed consistently better than current viral load. Given the simplicity in assessing and interpreting this indicator, we propose to use current viral load when HIV-RNA-based indicators are used to evaluate the efficacy of ART programs.
ISSN:02699370
DOI:10.1097/qad.0000000000001144