Identifying individuals with virologic failure after initiating effective antiretroviral therapy: The surprising value of mean corpuscular hemoglobin in a cross-sectional study.

AIDS Research and Therapy
Bryan LauRichard Moore

Abstract

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. 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. 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 0.85, and a sensitivity and specificity of 0.74 (95% CI: 0.69-0.79) and 0.89 (95% CI...Continue Reading

References

Nov 3, 1989·JAMA : the Journal of the American Medical Association·M A FischlR T Schooley
May 20, 1998·Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology : Official Publication of the International Retrovirology Association·R D Moore
Aug 5, 1999·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·D M Simpson
Oct 25, 2002·AIDS Patient Care and STDs·Frank RomanelliClaire Pomeroy
Nov 8, 2008·Journal of Acquired Immune Deficiency Syndromes : JAIDS·David M MooreJonathan Mermin

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Sep 17, 2013·Journal of Clinical Laboratory Analysis·Ah Hyun KimEun-Jee Oh

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