BACKGROUND: This study evaluated a wide range of viral load (VL) thresholds to identify a cut-point that best predicts new clinical events in children on stable highly active antiretroviral therapy (HAART). METHODS: Cox proportional hazards modeling was used to assess the adjusted risk for World Health Organization stage 3 or 4 clinical events (WHO events) as a function of time-varying CD4, VL, and hemoglobin values in a cohort study of Latin American children on HAART ≥6 months. Models were fit using different VL cut-points between 400 and 50,000 copies per milliliter, with model fit evaluated on the basis of the minimum Akaike information criterion value, a standard model fit statistic. RESULTS: Models were based on 67 subjects with WHO events out of 550 subjects on study. The VL cut-points of >2600 and >32,000 copies per milliliter corresponded to the lowest Akaike information criterion values and were associated with the highest hazard ratios (2.0, P = 0.015; and 2.1, P = 0.0058, respectively) for WHO events. CONCLUSIONS: In HIV-infected Latin American children on stable HAART, 2 distinct VL thresholds (>2600 and >32,000 copies/mL) were identified for predicting children at significantly increased risk for HIV-related clinical illness, after accounting for CD4 level, hemoglobin level, and other significant factors.
BACKGROUND: This study evaluated a wide range of viral load (VL) thresholds to identify a cut-point that best predicts new clinical events in children on stable highly active antiretroviral therapy (HAART). METHODS: Cox proportional hazards modeling was used to assess the adjusted risk for World Health Organization stage 3 or 4 clinical events (WHO events) as a function of time-varying CD4, VL, and hemoglobin values in a cohort study of Latin American children on HAART ≥6 months. Models were fit using different VL cut-points between 400 and 50,000 copies per milliliter, with model fit evaluated on the basis of the minimum Akaike information criterion value, a standard model fit statistic. RESULTS: Models were based on 67 subjects with WHO events out of 550 subjects on study. The VL cut-points of >2600 and >32,000 copies per milliliter corresponded to the lowest Akaike information criterion values and were associated with the highest hazard ratios (2.0, P = 0.015; and 2.1, P = 0.0058, respectively) for WHO events. CONCLUSIONS: In HIV-infected Latin American children on stable HAART, 2 distinct VL thresholds (>2600 and >32,000 copies/mL) were identified for predicting children at significantly increased risk for HIV-related clinical illness, after accounting for CD4 level, hemoglobin level, and other significant factors.
Authors: W T Shearer; T C Quinn; P LaRussa; J F Lew; L Mofenson; S Almy; K Rich; E Handelsman; C Diaz; M Pagano; V Smeriglio; L A Kalish Journal: N Engl J Med Date: 1997-05-08 Impact factor: 91.245
Authors: P E Palumbo; C Raskino; S Fiscus; S Pahwa; M G Fowler; S A Spector; J A Englund; C J Baker Journal: JAMA Date: 1998-03-11 Impact factor: 56.272
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Authors: Abdel Babiker; Hannah Castro nee Green; Alexandra Compagnucci; Susan Fiscus; Carlo Giaquinto; Diana M Gibb; Lynda Harper; Linda Harrison; Michael Hughes; Ross McKinney; Ann Melvin; Lynne Mofenson; Yacine Saidi; M Elizabeth Smith; Gareth Tudor-Williams; A Sarah Walker Journal: Lancet Infect Dis Date: 2011-01-31 Impact factor: 25.071
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