title: Benefit of viral load testing for confirmation of immunological failure in HIV patients treated in rural Malawi.
abstract: OBJECTIVE
  Viral load testing is used in the HIV programme of Chiradzulu, Malawi, to confirm the diagnosis of immunological failure to prevent unnecessary switching to second-line therapy. Our objective was to quantify the benefit of this strategy for management of treatment failure in a large decentralized HIV programme in Africa.
  
  
  METHODS
  Retrospective analysis of monitoring data from adults treated with first-line antiretroviral regimens for >1 year and meeting the WHO immunological failure criteria in an HIV programme in rural Malawi. The positive predictive value of using immunological failure criteria to diagnose virological failure (viral load >5000 copies/ml) was estimated.
  
  
  RESULTS
  Of the 227 patients with immunological failure (185 confirmed with a repeat CD4 measurement), 155 (68.2%) had confirmatory viral load testing. Forty-four (28.4%) had viral load >5000 copies/ml and 57 (36.8%) >1000 copies/ml. Positive predictive value was 28.4% (95% CI 21.4-36.2%). Repeat CD4 count testing showed that 41% of patients initially diagnosed with immunological failure did no longer meet failure criteria.
  
  
  CONCLUSIONS
  Our results support the need for confirming all cases of immunological failure with viral load testing before switching to second-line ART to optimize the use of resources in developing countries.
authors: Médecins Sans Frontières, Chiradzulu, Malawi.
authors: Rupa
authors: R
authors: Kanapathipillai
authors: Megan
authors: M
authors: McGuire
authors: Robert
authors: R
authors: Mogha
authors: Elisabeth
authors: E
authors: Szumilin
authors: Annette
authors: A
authors: Heinzelmann
authors: Mar
authors: M
authors: Pujades-Rodríguez
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D006801:Humans; D008295:Malawi; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012423:Rural Health; D017211:Treatment Failure; D019562:Viral Load / Q000379:methods*
chemical_list: D044966:Anti-Retroviral Agents