tailieunhanh - Báo cáo y học: "Identifying individuals with virologic failure after initiating effective antiretroviral therapy: The surprising va"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Identifying individuals with virologic failure after initiating effective antiretroviral therapy: The surprising value of mean corpuscular hemoglobin in a cross-sectional study. | Lau et al. AIDS Research and Therapy 2010 7 25 http content 7 1 25 AIDS RESEARCH AND THERAPY RESEARCH Open Access Identifying individuals with virologic failure after initiating effective antiretroviral therapy The surprising value of mean corpuscular hemoglobin in a cross-sectional study Bryan Lau1 Geetanjali Chander2 Stephen J Gange1 Richard D Moore1 2 Abstract Objective Recent studies have shown that the current guidelines suggesting immunologic monitoring to determine response to highly active antiretroviral therapy HAART are inadequate. We assessed whether routinely collected clinical markers could improve prediction of concurrent HIV RNA levels. Methods We included individuals followed within the Johns Hopkins HIV Clinical Cohort who initiated antiretroviral therapy and had concurrent HIV RNA and biomarker measurements 4 months after HAART. A two tiered approach to determine whether clinical markers could improve prediction included 1 identification of predictors of HIV RNA levels 500 copies ml and 2 construction and validation of a prediction model. Results Three markers mean corpuscular hemoglobin MCH CD4 and change in percent CD4 from pre-HAART levels in addition to the change in MCH from pre-HAART levels contained the most predictive information for identifying an HIV RNA 500 copies ml. However MCH and change in MCH were the two most predictive followed by CD4 and change in percent CD4. The logistic prediction model in the validation data had an area under the receiver operating characteristic curve of and a sensitivity and specificity of 95 CI and 95 CI respectively. Conclusions Immunologic criteria have been shown to be a poor guideline for identifying individuals with high HIV RNA levels. MCH and change in MCH were the strongest predictors of HIV RNA levels 500. When combined with CD4 and percent CD4 as covariates in a model a high level of discrimination between those with and without HIV RNA .

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