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

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Siberry, George K.
Harris, D. Robert
Oliveira, Ricardo Hugo
Krauss, Margot R.
Hofer, Cristina B.
Tiraboschi, Adriana Aparecida
Marques, Heloisa
Succi, Regina C. [UNIFESP]
Abreu, Thalita
Della Negra, Marinella
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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.
Jaids-Journal of Acquired Immune Deficiency Syndromes. Philadelphia: Lippincott Williams & Wilkins, v. 60, n. 2, p. 214-218, 2012.