Autor/a:
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Pastor, Lucía; Casellas, Aina; Rupérez, María; Carrillo, Jorge; Maculuve, Sónia Amós; Jairoce, Chenjerai; Paredes, Roger; Blanco, Julià; Naniche, Denise
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Abstract:
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Background: Achieving effective antiretroviral treatment (ART)
monitoring is a key determinant to ensure viral suppression and
reach the UNAIDS 90-90-90 targets. The gold standard for
detecting virological failure is plasma human immunodeficiency
virus (HIV) RNA (viral load [VL]) testing; however, its
availability is very limited in low-income countries due to cost
and operational constraints. Methods: HIV-1-infected adults on
first-line ART attending routine visits at the Manhica District
Hospital, Mozambique, were previously evaluated for virologic
failure. Plasma levels of interferon-gamma-inducible protein 10
(IP-10) were quantified by enzyme-linked immunosorbent assay.
Logistic regression was used to build an IP-10-based model able
to identify individuals with VL >150 copies/mL. From the 316
individuals analyzed, 253 (80%) were used for model training and
63 (20%) for validation. Receiver operating characteristic
curves were employed to evaluate model prediction. Results: From
the individuals included in the training set, 34% had detectable
VL. Mean age was 41 years, 70% were females, and median time on
ART was 3.4 years. IP-10 levels were significantly higher in
subjects with detectable VL (108.2 pg/mL) as compared to those
with undetectable VL (38.0 pg/mL) (P < .0001, U test). IP-10
univariate model demonstrated high classification performance
(area under the curve = 0.85 [95% confidence interval {CI},
.80-.90]). Using a cutoff value of IP-10 >/=44.2 pg/mL, the
model identified detectable VL with 91.9% sensitivity (95% CI,
83.9%-96.7%) and 59.9% specificity (95% CI, 52.0%-67.4%), values
confirmed in the validation set. Conclusions: IP-10 is an
accurate biomarker to screen individuals on ART for detectable
viremia. Further studies should evaluate the benefits of IP-10
as a triage approach to monitor ART in resource-limited
settings. |