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. 2012 Jun 1;60(2):214-8.
doi: 10.1097/QAI.0b013e31824e4da6.

Evaluation of viral load thresholds for predicting new World Health Organization stage 3 and 4 events in HIV-infected children receiving highly active antiretroviral therapy

George K Siberry  1 , D Robert Harris, Ricardo Hugo Oliveira, Margot R Krauss, Cristina B Hofer, Adriana Aparecida Tiraboschi, Heloisa Marques, Regina C Succi, Thalita Abreu, Marinella Della Negra, Lynne M Mofenson, Rohan Hazra; NISDI PLACES Protocol
Collaborators, Affiliations

Evaluation of viral load thresholds for predicting new World Health Organization stage 3 and 4 events in HIV-infected children receiving highly active antiretroviral therapy

George K Siberry et al. J Acquir Immune Defic Syndr. .

Abstract

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.

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Conflict of interest statement

Conflicts of Interest: All authors confirm that they have NO financial arrangement with any company whose product or competing product plays a role in the manuscript.

Figures

Figure 1
Figure 1
Akaike Information Criterion (AIC) goodness-of-fit measure plotted as a function of HIV viral load cut-points
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