Bryant Leeann, Smith Nathaniel, Keiser Philip
Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0435, USA.
J Int Assoc Provid AIDS Care. 2013 Jan-Feb;12(1):67-71. doi: 10.1177/1545109712442007. Epub 2012 May 2.
Viral load monitoring of antiretroviral therapy in low-income countries is rarely used because of high costs. Reducing the frequency of monitoring may make it financially feasible.
We modeled three testing schemes: reduced viral load monitoring (RVLM) with CD4 count at baseline and viral load testing at 6, 36, and 60 months; United States Department of Health and Human Services (US DHHS) Treatment Guidelines; and World Health Organization (WHO) Guidelines using a cohort of 313 HIV-infected patients using Kaplan-Meier analysis.
Median time to detection of antiretroviral therapy (ART) failure using RVLM was 147 days; using US DHHS, it was 115 days; and using WHO guidelines, it was 1110 days. Median time for the development of first thymidine analog mutation was 594 days. The cost of RVLM was significantly lower than US DHHS.
RVLM detected failure significantly sooner than CD4 count monitoring alone at a lower cost than US DHHS monitoring. RVLM is a potentially effective method of monitoring ART in resource-limited settings.
由于成本高昂，低收入国家很少使用抗逆转录病毒疗法的病毒载量监测。降低监测频率可能使其在经济上可行。
我们对三种检测方案进行了建模：基线时进行CD4细胞计数并在6个月、36个月和60个月时进行病毒载量检测的减少病毒载量监测（RVLM）；美国卫生与公众服务部（US DHHS）治疗指南；以及世界卫生组织（WHO）指南，使用313名HIV感染患者的队列进行Kaplan-Meier分析。
使用RVLM检测抗逆转录病毒疗法（ART）失败的中位时间为147天；使用US DHHS为115天；使用WHO指南为1110天。首次出现胸苷类似物突变的中位时间为594天。RVLM的成本显著低于US DHHS。
与单独进行CD4细胞计数监测相比，RVLM能以低于US DHHS监测的成本更早地检测到失败。RVLM是在资源有限环境中监测ART的一种潜在有效方法。
