Associations between HIV-RNA-based indicators and virological and clinical outcomes

Kamilla G Laut, Leah C Shepherd, Court Pedersen, Jürgen K Rockstroh, Helen Sambatakou, Dimitry Paduta, Raimonda Matulionyte, Tomasz Smiatacz, Fiona Mulcahy, Jens D. Lundgren, Amanda Mocroft, Ole Kirk, EuroSIDA in EuroCoord, Mauro Zaccarelli, Andrea Antinori, Rosa Antonietta Acinapura, Maria Maddalena Plazzi

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To evaluate and compare the performance of six HIV-RNA-based quality of care indicators for predicting short-term and long-term outcomes.

DESIGN: Multinational cohort study.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

Original languageEnglish
Pages (from-to)1961-72
Number of pages12
JournalAIDS (London, England)
Volume30
Issue number12
DOIs
Publication statusPublished - Jul 31 2016

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Viral Load
HIV
RNA
ROC Curve
Area Under Curve
Quality of Health Care
Viremia
Therapeutics
Acquired Immunodeficiency Syndrome
Cohort Studies
Mortality
Incidence

Keywords

  • Journal Article

Cite this

Laut, K. G., Shepherd, L. C., Pedersen, C., Rockstroh, J. K., Sambatakou, H., Paduta, D., ... Plazzi, M. M. (2016). Associations between HIV-RNA-based indicators and virological and clinical outcomes. AIDS (London, England), 30(12), 1961-72. https://doi.org/10.1097/QAD.0000000000001144

Associations between HIV-RNA-based indicators and virological and clinical outcomes. / Laut, Kamilla G; Shepherd, Leah C; Pedersen, Court; Rockstroh, Jürgen K; Sambatakou, Helen; Paduta, Dimitry; Matulionyte, Raimonda; Smiatacz, Tomasz; Mulcahy, Fiona; Lundgren, Jens D.; Mocroft, Amanda; Kirk, Ole; EuroSIDA in EuroCoord ; Zaccarelli, Mauro; Antinori, Andrea; Acinapura, Rosa Antonietta; Plazzi, Maria Maddalena.

In: AIDS (London, England), Vol. 30, No. 12, 31.07.2016, p. 1961-72.

Research output: Contribution to journalArticle

Laut, KG, Shepherd, LC, Pedersen, C, Rockstroh, JK, Sambatakou, H, Paduta, D, Matulionyte, R, Smiatacz, T, Mulcahy, F, Lundgren, JD, Mocroft, A, Kirk, O, EuroSIDA in EuroCoord, Zaccarelli, M, Antinori, A, Acinapura, RA & Plazzi, MM 2016, 'Associations between HIV-RNA-based indicators and virological and clinical outcomes', AIDS (London, England), vol. 30, no. 12, pp. 1961-72. https://doi.org/10.1097/QAD.0000000000001144
Laut KG, Shepherd LC, Pedersen C, Rockstroh JK, Sambatakou H, Paduta D et al. Associations between HIV-RNA-based indicators and virological and clinical outcomes. AIDS (London, England). 2016 Jul 31;30(12):1961-72. https://doi.org/10.1097/QAD.0000000000001144
Laut, Kamilla G ; Shepherd, Leah C ; Pedersen, Court ; Rockstroh, Jürgen K ; Sambatakou, Helen ; Paduta, Dimitry ; Matulionyte, Raimonda ; Smiatacz, Tomasz ; Mulcahy, Fiona ; Lundgren, Jens D. ; Mocroft, Amanda ; Kirk, Ole ; EuroSIDA in EuroCoord ; Zaccarelli, Mauro ; Antinori, Andrea ; Acinapura, Rosa Antonietta ; Plazzi, Maria Maddalena. / Associations between HIV-RNA-based indicators and virological and clinical outcomes. In: AIDS (London, England). 2016 ; Vol. 30, No. 12. pp. 1961-72.
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AU - Laut, Kamilla G

AU - Shepherd, Leah C

AU - Pedersen, Court

AU - Rockstroh, Jürgen K

AU - Sambatakou, Helen

AU - Paduta, Dimitry

AU - Matulionyte, Raimonda

AU - Smiatacz, Tomasz

AU - Mulcahy, Fiona

AU - Lundgren, Jens D.

AU - Mocroft, Amanda

AU - Kirk, Ole

AU - EuroSIDA in EuroCoord

AU - Zaccarelli, Mauro

AU - Antinori, Andrea

AU - Acinapura, Rosa Antonietta

AU - Plazzi, Maria Maddalena

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N2 - OBJECTIVES: To evaluate and compare the performance of six HIV-RNA-based quality of care indicators for predicting short-term and long-term outcomes.DESIGN: Multinational cohort study.METHODS: 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.RESULTS: 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.CONCLUSION: 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.

AB - OBJECTIVES: To evaluate and compare the performance of six HIV-RNA-based quality of care indicators for predicting short-term and long-term outcomes.DESIGN: Multinational cohort study.METHODS: 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.RESULTS: 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.CONCLUSION: 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.

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JF - AIDS

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