1087. Performance of WHO immunological response to predict virological failure in patients with severe versus moderate immunosuppression at antiretroviral therapy initiation
Session: Poster Abstract Session: HIV: Resistance
Friday, October 9, 2015
Room: Poster Hall
  • Martin_ekat_P_1087.pdf (182.8 kB)
  • Background: To evaluate sensitivity and specificity of WHO-immunological criteria (CI) to predict virological failure (EV) among patients with severe (who have high incidence of opportunistic infections) versus moderate immunosuppression at ART initiation.

    Methods: HIV-positive patients naive to antiretroviral therapy (ART) follow-up between January 2004 and December 2011, at Ambulatory Treatment Center of Brazzaville(CTA), Congo, and Age ≥18 years on ART since ≥12 month with combination of 2NRTIs plus 1INNTI; Were divided into two groups: G1=severe (CD4 < 200) and G2=moderate (CD4 ≥200-350) immunosuppression. CI was defined as: CD4 cell count < 100 cell/mL after 12 month, >50% drop from CD4 count peak and CD4 cell count lower than baseline. Sensitivity of CI to predict EV was analyzed across level of viral load ≥1000copies/ml

    Results: We included 329 patients in G1 and 216 in G2. The median values at baseline were: Age: 44years (Inter Quartile Range (IQR):37-50) versus 43years (IQR: 37-51), p=0.99; CD4: 104 cells/mm3 (IQR: 53-162) versus 264 cells/mm3 (IQR 230-303), p< 0.00, prior AIDS illness: 72.9% versus 64.4%, p=0.02. Over the eight-year study period, in the first 12-months follow-up on ART incidence rate of opportunistic infections was 3 versus 1.2 per 100 person-years, p< 0.001 and 16.9% versus 16%, p=0.49, 10.3% versus 9%, p=0.42 patients respectively had confirmed virological and immunological failure in G1 and G2 respectively, only 7 patients (2.13%) versus 3 patients (1.38%) met both the IC and EV. Performance of CI was: sensitivity: 27.9%(95%CI: 17-40) versus 48%(95%CI:34-67), specificity :88.5%(95%CI:84-92) versus 83.5%(95%CI: 77-89), PPV :38.8%(95%CI: 25-54) versus 47%(95%CI: 33-62), NPV :82.4 %(95%CI: 78-87) value 84%(95%CI: 78-89), LR+ :2.4(95%CI:1.5-4) versus 2.9(95%CI: 1.9-4.6) and LR-: 0.8(95%CI:0.7-1) versus 0.6(95%CI: 0.5-0.8) respectively in G1 and G2.

    Conclusion: Severe immunosuppression at initiation of ART is not associated with the low sensitivity of WHO-immunological criteria. Viral load, reference tools for the diagnosis of failure should be available in resource-constrained settings.

    Martin Herbas Ekat, M.D., Merlin Diafouka, M.D. and Patrick Nzounza, M.D., Ambulatory Treatment Center of Brazzaville, Brazzaville, Congo-Brazzaville


    M. H. Ekat, None

    M. Diafouka, None

    P. Nzounza, None

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