title: Associations between HIV-RNA-based indicators and virological and clinical outcomes.
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.
authors.affiliation: aCHIP, Centre for Health & Infectious Diseases Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark bHIV Epidemiology and Biostatistics Unit, Department Infection and Population Health, University College London, London, United Kingdom cDepartment of Infectious Diseases, Odense University Hospital, Odense, Denmark dImmunologische Ambulanz, University Hospital Bonn, Bonn, Germany e2nd Department of Internal Medicine, Hippokration General Hospital, University of Athens, Athens, Greece fEpidemiology and Healthcare, Gomel Regional Centre for Hygiene, Gomel, Belarus gDepartment of Infectious, Chest diseases, Dermatovenerology and Allergology, Vilnius University; Centre of Infectious Diseases, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania hDepartment of Infectious Diseases, Medical University Gdansk, Gdansk, Poland iThe Guide Clinic, St James' Hospital, Dublin, Ireland.
authors.forename: Kamilla G
authors.initials: KG
authors.lastname: Laut
authors.forename: Leah C
authors.initials: LC
authors.lastname: Shepherd
authors.forename: Court
authors.initials: C
authors.lastname: Pedersen
authors.forename: Jürgen K
authors.initials: JK
authors.lastname: Rockstroh
authors.forename: Helen
authors.initials: H
authors.lastname: Sambatakou
authors.forename: Dimitry
authors.initials: D
authors.lastname: Paduta
authors.forename: Raimonda
authors.initials: R
authors.lastname: Matulionyte
authors.forename: Tomasz
authors.initials: T
authors.lastname: Smiatacz
authors.forename: Fiona
authors.initials: F
authors.lastname: Mulcahy
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.forename: Ole
authors.initials: O
authors.lastname: Kirk
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood*; D016019:Survival Analysis; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D012367:RNA, Viral