Could Caregiver Reporting Adherence Help Detect Virological Failure in Cameroonian Early Treated HIV-Infected Infants?

Viral load is still the marker of choice for monitoring adherence to combined antiretroviral therapy (cART) and confirming the success of HIV treatment. Unfortunately it is difficult to access in many resource-poor settings. We aimed to measure the performance of caregiver reporting adherence for detecting virological failure in routine practice during the first 2 years after cART initiation in infants.

PEDIACAM is an ongoing prospective cohort study including HIV1-infected infants diagnosed before 7 months of age between November 2007 and October 2011 in Cameroon. Adherence was assessed using a questionnaire administered every 3 months from cART initiation; the HIV-RNA viral load was determined at the same visits. Virological failure was defined as having a viral load ≥ 1000 cp/mL at 3 and 12 months after cART initiation or having a viral load ≥ 400 cp/mL at 24 months after cART initiation. The performance of each current missed and cumulative missed dose defined according to adherence as reported by caregiver was assessed using the viral load as the gold standard.

cART was initiated at a median age of 4 months (IQR: 3–6) in the 167 infants included. The cumulative missed dose showed the best overall performance for detecting virological failure after 12 months of cART (AUC test, p = 0.005, LR + =4.4 and LR− = 0.4). Whatever the adherence reporting criterion, the negative predictive value was high (NPV ≥ 75 %) 12 and 24 months after cART initiation, whereas the positive predictive value was low (PPV ≤ 50 %).

The adherence questionnaire administered by the health care provider to the infants’ caregivers is not reliable for detecting virological failure in routine practice: its positive predictive value is low. However, the cumulative missed dose measurement may be a reliable predictor of virological success, particularly after 12 months of cART, given its high negative predictive value.

Below: ROC curve for various reporting adherence criteria (ANRS-PEDIACAM Study, 2008-2013, Cameroon). Legend: cART, combined antiretroviral therapy

Read more at:  http://ht.ly/Svnms 

By: Francis Ateba Ndongo^1*, Josiane Warszawski², Gaetan Texier³, Ida Penda⁵, Suzie Tetang Ndiang⁶, Jean-Audrey Ndongo⁷, Georgette Guemkam⁷, Casimir Ledoux Sofeu⁸,Anfumbom Kfutwah⁹, Albert Faye¹⁰, Philippe Msellati¹¹, Mathurin Cyrille Tejiokem⁴ andthe ANRS-PEDIACAM study group

¹Université Paris-Sud; Centre Mère et Enfant de la Fondation Chantal Biya, Yaounde, Cameroon

²Université Paris-Sud; Assistance Publique des Hôpitaux de Paris, CESP INSERM U1018, team 4 “HIV and STD”; Hôpital Bicêtre, Le Kremlin-Bicêtre, 94276, France

³SESSTIM (UMR 912) Aix-Marseille Université, Marseille, France

⁴Centre Pasteur du Cameroun, Service d’Epidémiologie et de Santé Publique, Yaounde, Cameroon

⁵Université Douala; Hôpital Laquintinie, Douala, POB 4035, Cameroon

⁶Centre Hospitalier d’Essos, Yaounde, Cameroon

⁷Centre Mère et Enfant de la Fondation Chantal Biya, Yaounde, Cameroon

⁸Université Yaoundé I; Centre Pasteur du Cameroun, Service d’Epidémiologie et de Santé Publique, Yaounde, Cameroon

⁹Centre Pasteur du Cameroun, Service de Virologie, Yaounde, Cameroon

¹⁰Université Paris Diderot, Sorbonne Paris Cité; Assistance Publique des Hôpitaux de Paris, Pédiatrie Générale, Hôpital Robert Debré, Paris, France

¹¹UMI 233, IRD, Université Montpellier, Montpellier, 34394, France