Biomaterial Database

A model for reduced HIV-1 viral load monitoring in resource-limited settings. 2013

Leeann Bryant, and Nathaniel Smith, and Philip Keiser

Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0435, USA.

BACKGROUND Viral load monitoring of antiretroviral therapy in low-income countries is rarely used because of high costs. Reducing the frequency of monitoring may make it financially feasible. METHODS We modeled three testing schemes: reduced viral load monitoring (RVLM) with CD4 count at baseline and viral load testing at 6, 36, and 60 months; United States Department of Health and Human Services (US DHHS) Treatment Guidelines; and World Health Organization (WHO) Guidelines using a cohort of 313 HIV-infected patients using Kaplan-Meier analysis. RESULTS Median time to detection of antiretroviral therapy (ART) failure using RVLM was 147 days; using US DHHS, it was 115 days; and using WHO guidelines, it was 1110 days. Median time for the development of first thymidine analog mutation was 594 days. The cost of RVLM was significantly lower than US DHHS. CONCLUSIONS RVLM detected failure significantly sooner than CD4 count monitoring alone at a lower cost than US DHHS monitoring. RVLM is a potentially effective method of monitoring ART in resource-limited settings.

UI	MeSH Term	Description	Entries
D003906	Developing Countries	Countries in the process of change with economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures.	LMICs,Less-Developed Countries,Low Income Countries,Low and Middle Income Countries,Lower-Middle-Income Country,Middle Income Countries,Third-World Countries,Under-Developed Countries,Developing Nations,Least Developed Countries,Less-Developed Nations,Third-World Nations,Under-Developed Nations,Countries, Middle Income,Countries, Third-World,Country, Least Developed,Country, Less-Developed,Country, Low Income,Country, Lower-Middle-Income,Country, Middle Income,Country, Third-World,Country, Under-Developed,Developed Country, Least,Developing Country,Developing Nation,Least Developed Country,Less Developed Countries,Less Developed Nations,Less-Developed Country,Less-Developed Nation,Low Income Country,Lower Middle Income Country,Lower-Middle-Income Countries,Middle Income Country,Nation, Less-Developed,Nation, Third-World,Nation, Under-Developed,Third World Countries,Third World Nations,Third-World Country,Third-World Nation,Under Developed Countries,Under Developed Nations,Under-Developed Country,Under-Developed Nation
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D015331	Cohort Studies	Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics.	Birth Cohort Studies,Birth Cohort Study,Closed Cohort Studies,Cohort Analysis,Concurrent Studies,Historical Cohort Studies,Incidence Studies,Analysis, Cohort,Cohort Studies, Closed,Cohort Studies, Historical,Studies, Closed Cohort,Studies, Concurrent,Studies, Historical Cohort,Analyses, Cohort,Closed Cohort Study,Cohort Analyses,Cohort Studies, Birth,Cohort Study,Cohort Study, Birth,Cohort Study, Closed,Cohort Study, Historical,Concurrent Study,Historical Cohort Study,Incidence Study,Studies, Birth Cohort,Studies, Cohort,Studies, Incidence,Study, Birth Cohort,Study, Closed Cohort,Study, Cohort,Study, Concurrent,Study, Historical Cohort,Study, Incidence
D015497	HIV-1	The type species of LENTIVIRUS and the etiologic agent of AIDS. It is characterized by its cytopathic effect and affinity for the T4-lymphocyte.	Human immunodeficiency virus 1,HIV-I,Human Immunodeficiency Virus Type 1,Immunodeficiency Virus Type 1, Human
D015658	HIV Infections	Includes the spectrum of human immunodeficiency virus infections that range from asymptomatic seropositivity, thru AIDS-related complex (ARC), to acquired immunodeficiency syndrome (AIDS).	HTLV-III Infections,HTLV-III-LAV Infections,T-Lymphotropic Virus Type III Infections, Human,HIV Coinfection,Coinfection, HIV,Coinfections, HIV,HIV Coinfections,HIV Infection,HTLV III Infections,HTLV III LAV Infections,HTLV-III Infection,HTLV-III-LAV Infection,Infection, HIV,Infection, HTLV-III,Infection, HTLV-III-LAV,Infections, HIV,Infections, HTLV-III,Infections, HTLV-III-LAV,T Lymphotropic Virus Type III Infections, Human
D016903	Drug Monitoring	The process of observing, recording, or detecting the effects of a chemical substance administered to an individual therapeutically or diagnostically.	Monitoring, Drug,Therapeutic Drug Monitoring,Drug Monitoring, Therapeutic,Monitoring, Therapeutic Drug
D017410	Practice Guidelines as Topic	Works about directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery.	Clinical Guidelines as Topic,Best Practices,Best Practice
D044966	Anti-Retroviral Agents	Agents used to treat RETROVIRIDAE INFECTIONS.	Antiretroviral Agent,Antiretroviral Agents,Agent, Antiretroviral,Agents, Anti-Retroviral,Agents, Antiretroviral,Anti Retroviral Agents
D018791	CD4 Lymphocyte Count	The number of CD4-POSITIVE T-LYMPHOCYTES per unit volume of BLOOD. Determination requires the use of a fluorescence-activated flow cytometer.	Lymphocyte Count, CD4,T4 Lymphocyte Count,CD4 Cell Counts,CD4 Counts,CD4+ Cell Counts,CD4+ Counts,CD4 Cell Count,CD4 Count,CD4 Lymphocyte Counts,CD4+ Cell Count,CD4+ Count,Count, T4 Lymphocyte,Counts, T4 Lymphocyte,Lymphocyte Count, T4,Lymphocyte Counts, CD4,Lymphocyte Counts, T4,T4 Lymphocyte Counts
D019562	Viral Load	The quantity of measurable virus in a body fluid. Change in viral load, measured in plasma, is sometimes used as a SURROGATE MARKER in disease progression.	Viral Burden,Virus Titer,Burden, Viral,Load, Viral,Titer, Virus