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Predictors of virological failure in a Cambodian setting: findings from a cross-sectional study at Sihanouk Hospital Centre of Hope, Phnom Penh
Presented by Sokkab An, Cambodia.
An S.1, Koole O.2, Haverkamp M.3, Sculier D.2, Thai S.1, Lynen L.2
1Sihanouk Hospital Center of HOPE, Infectious Diseases, Phnom Penh, Cambodia, 2Institute of Tropical Medicine, Antwerp, Belgium, 3Brown University, Providence, United States
Objectives: Sensitivity and specificity of the WHO 2003 guidelines for treatment failure and additional parameters were assessed as predictors for virological failure in a Cambodian hospital.
Methods: Adults on HAART for at least 6 months participated in this cross-sectional study. Virological failure was defined as > 50 copies/ml. Onset or recurrence of WHO stage III/IV conditions after the first 3 months of HAART (excluding TB) characterized clinical failure. CD4 decrease to pre-therapy baseline or below and decline >50% from peak level defined immunological failure.Continuous variables (change in CD4, total lymphocyte count (TLC), haemoglobin and body mass index) were categorized using ROC analysis. Predictors for failure were examined using multivariate logistic regression (model variables: change in CD4, TLC, Hb and BMI, clinical failure, ART experience, number of switches, adherence, PPE, gender and age).
Results: 399 patients were included, 33 patients (8.3%) had a detectable VL. Median time on HAART was 12.8 months (10.7 – 19.5 months). Comparing the clinical and immunological criteria with the VL results gave a sensitivity of 18% and specificity of 91% with a negative predictive value (NPV) of 93%, and a sensitivity of 35% and specificity of 95% with an NPV of 94%, respectively.
Men were more likely to fail virologically than women (adjusted OR 3.1 [1.3 – 7.3], p=0.008). Patients with a decreased or stable CD4 over the previous six months had 2.6 times higher odds of failing (adjusted OR=2.6 [1.2 – 5.6]; p=0.016). A TLC decrease of more than 300 over the same period of time increased the odds of failure almost three fold (adjusted OR 2.9 [1.4 – 6.3]; p=0.006).
Conclusions: Although the sensitivity of the 2003 WHO criteria for treatment failure is low in this Cambodian setting, their high NPV helps to identify patients that might not need a viral load to make a treatment decision.
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