1565Identifying Optimal HIV Viral Load (VL) Thresholds for Predicting Antiretroviral Treatment Failure (TF) Using ROC Curve Analysis

Abstract Background Antiretroviral treatment (ART) is aimed for complete suppression of viral replication but it fails for a variety of reasons. The aim of this study was to determine the prevalence and associated factors of treatment failure among people on first line ART in Amhara region, North east Ethiopia.Methods A cross sectional study was conducted from March, 2018 to July, 2018. Questionnaire survey using a pre-structured questionnaire was taken focusing on demographic data and possible risk factors of antiretroviral treatment failure. Clinical history including baseline characteristics was extracted by reviewing medical records using data abstraction sheet and data was analyzed using STATA version 14.Results A total of 640 clients of all age from 16 health facilities were enrolled in the study. The overall antiretroviral treatment failure was 16.45% from which clinical, immunologic and virologic failure were 0.47%, 13.59% and 3.13% respectively. The viral suppression was 91.09%, but more than half, 29 (50.88%) study participants with high first viral load (>1000copies/ml) were defaulted and not tested for the 2 nd viral load testing. Binary and multivariable logistic regression analysis showed significance association of treatment failure with age at treatment initiation (OR, 1.029), duration on ART (OR, 0.87) and adherence (AOR, 4.22). High proportion of treatment failure was also found in females (62.75%) and in those below primary education (76.47%).Conclusions In conclusion increased viral suppression is observed but the rate of default during 3 month of enhanced adherence counseling is high. The overall magnitude of treatment failure in Amhara region is 16.45%. Fair/poor adherence, older age at treatment initiation and shorter duration on ART are significantly independent factors of treatment failure. Therefore improving client follow up to adherence to treatment should be strengthened.

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Immunologic and Clinical Failure of Antiretroviral Therapy in People Living with Human Immunodeficiency Virus within Two Years of Treatment

BioMed Research International ◽

10.1155/2020/5474103 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Solomon Weldegebreal Asgedom ◽

Mahlet Maru ◽

Beletu Berihun ◽

Kidu Gidey ◽

Yirga Legesse Niriayo ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Viral Load ◽

Antiretroviral Therapy ◽

Treatment Failure ◽

Antiretroviral Treatment ◽

Cox Regression ◽

Statistical Significance ◽

Cox Regression Analysis ◽

Immunodeficiency Virus ◽

Antiretroviral Treatment Failure

Background. Early initiation of highly active antiretroviral therapy (HAART) decreases human immunodeficiency virus- (HIV-) related complications, restores patients’ immunity, decreases viral load, and substantially improves quality of life. However, antiretroviral treatment failure considerably impedes the merits of HAART. Objective. This study is aimed at determining the prevalence of immunologic and clinical antiretroviral treatment failure. Methods. A cross-sectional study design using clinical and immunologic treatment failure definition was used to conduct the study. Sociodemographic characteristics and clinical features of patients were retrieved from patients’ medical registry between the years 2009 and 2015. All patients who fulfilled the inclusion criteria in the study period were studied. Predictors of treatment failure were identified using Kaplan-Meier curves and multivariable Cox regression analysis. Data analysis was done using SPSS version 21 software, and the level of statistical significance was declared at a p value < 0.05. Results. A total of 770 were studied. The prevalence of treatment failure was 4.5%. The AZT-based regimen (AHR=16.95, 95% CI: 3.02-95.1, p=0.001), baseline CD4 count≥301 (AHR=0.199, 95% CI: 0.05-0.76, p=0.018), and bedridden during HAART initiation (AHR=0.131, 95% CI: 0.029-0.596, p=0.009) were the predictors of treatment failure. Conclusion. The prevalence of treatment failure was lower with the risk being higher among patients on the AZT-based regimen. On the other hand, the risk of treatment failure was lower among patients who started HAART at baseline CD4 count≥301 and patients who were bedridden during HAART initiation. We recommend further prospective, multicenter cohort studies to be conducted to precisely detect the prevalence of treatment failure using viral load determination in the whole country.

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Pooled HIV-1 RNA Viral Load Testing for Detection of Antiretroviral Treatment Failure in Kenyan Children

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0b013e318292f9cd ◽

2013 ◽

Vol 63 (3) ◽

pp. e87-e93 ◽

Cited By ~ 5

Author(s):

Bhavna H. Chohan ◽

Kenneth Tapia ◽

Michele Merkel ◽

Arphaxad C. Kariuki ◽

Brian Khasimwa ◽

...

Keyword(s):

Viral Load ◽

Treatment Failure ◽

Antiretroviral Treatment ◽

Load Testing ◽

Viral Load Testing ◽

Hiv 1 ◽

Antiretroviral Treatment Failure

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Detection of Antiretroviral treatment failure among adult HIV-1 patients on anti-retroviral therapy for 12 +/- 3 months attending different Voluntary Counseling Testing and treatment centers in Khartoum state, Sudan

10.21203/rs.3.rs-96321/v1 ◽

2020 ◽

Author(s):

Nafisa Ahmed Ibrahim ◽

Khalid A Enan ◽

Mahdi Mustafa Yagoup ◽

Wafa Ibrahim Elhag

Keyword(s):

Viral Load ◽

Antiretroviral Therapy ◽

Treatment Failure ◽

Antiretroviral Treatment ◽

Clinical Staging ◽

Age Group ◽

First Line ◽

Voluntary Counseling ◽

Hiv 1 ◽

Antiretroviral Treatment Failure

Abstract Objective: Small number of people on antiretroviral therapy and their virological status in Sudan is lacking. This study aimed to determine the viral load for adult HIV-1 patients who were on antiretroviral therapy for 12+/- 3 months attending different Voluntary Counseling Testing and treatment centers (VCT/ART) in Khartoum state, Sudan.Results: out of 112 adult HIV-1 patients included in this study, only 17.9% (20/112) showed unsuppressed viral load (treatment failure). The majority of them from Omdurman VCT/ART center 80% (16/20), followed by Khartoum VCT/ART center 15% (3/20), Bahri VCT/ART center 5% (1/20) and non from Elban Gadeid VCT/ART center. All of them were on the first line of treatment. Most of them 30% (6/20) on 39-48 years old age group, the majority of them 55%(11/20) on stage 3 WHO clinical staging.

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Evaluation of BCR-ABL/ABL Ratio Increase That Corresponds to BCR-ABL Mutation In Chronic Myeloid Leukemia Patients Treated by Imatinib.

Blood ◽

10.1182/blood.v116.21.3422.3422 ◽

2010 ◽

Vol 116 (21) ◽

pp. 3422-3422

Author(s):

Grigory Tsaur ◽

Anna Ivanova ◽

Alexander Popov ◽

Yulia Yakovleva ◽

Tatyana Riger ◽

...

Keyword(s):

Treatment Failure ◽

Roc Curve ◽

Mutation Detection ◽

Mutation Screening ◽

Point Mutations ◽

Threshold Level ◽

Curve Analysis ◽

Roc Curve Analysis ◽

Ratio Increase ◽

Predictive Values

Abstract Abstract 3422 Introduction. Currently there is no consensus in definition what level of BCR-ABL/ABL ratio increase predicts presence of kinase domain (KD) mutations. Several research groups use relatively low cut-off levels equal to 2.0- and 2.6-fold (S. Branford et al, Blood, 2004, R. Press et al Blood, 2009, respectively), that are close to the discrimination ability of real–time quantitative PCR (RQ-PCR) method. Alternatively, an NCCN guideline recommends beginning of mutation screening in case of 10-fold or greater elevation of BCR-ABL/ABL ratio. Aim. To define a threshold level of BCR-ABL/ABL increase that predicts presence of BCR-ABL mutations. Methods. Among 531 CML patients on imatinib (IM), both newly diagnosed and pre-treated with interferon-α, in 47 ones BCR-ABL mutation detection was performed. These were patients with suboptimal response or treatment failure according to the European LeukemiaNet criteria (M. Baccarani et al, 2009). Conventional cytogenetic analysis was performed every 6 months. Quantitative measurement of BCR-ABL/ABL transcripts ratio by RQ-PCR was done every 3–6 months. A major molecular response was defined as BCR-ABL/ABL transcripts level of 0.059% corresponded to 3 log reduction from the laboratory defined baseline level. Point mutations in the BCR-ABL KD were detected by reverse-transcriptase PCR and direct sequencing. Elevation of BCR-ABL/ABL was calculated by dividing of BCR-ABL/ABL value at the time point (TP) where mutation detection was performed to the BCR-ABL/ABL value at TP prior to mutation screening. Event-free survival (EFS) was defined as the time from IM beginning until any of the following events occurred: loss of complete hematological response, loss of major cytogenetic response, progression to AP/BC, death of any reason. Threshold level was defined by receiver operator characteristics (ROC) curve analysis. Positive and negative predictive values (PPV, NPV), sensitivity, specificity and overall correct prediction (OCP) were calculated. Results. 10 different point mutations of BCR-ABL gene were detected, including 3 ones in P-loop, 2 in IM-binding site, 3 in A-loop, and 2 mutations outside the KD. None of patients had 2 or more mutations simultaneously. Patients were divided into two groups: with (n=18) and without (n=29) BCR-ABL mutations. Groups did not differ in age, sex distribution, type of BCR-ABL transcript, frequency of cumulative achievement of CHR, CCyR, MMR and level of BCR-ABL/ABL increase (table 1). Median time between BCR-ABL/ABL measurement was similar in both groups: 6 months (range 1–12 months) (p=0.227). ROC curve analysis determined that increasing of BCR-ABL/ABL level in 5.5-fold corresponds to 92.9% of NPV. Area under curve was 68% (95% CI 50–95%) (p=0.022). Sensitivity, PPV and OCP were relatively low (40.6%, 40.6%, 56.5%, respectively) while specificity was high (92.9%). Conclusions. In our series 5.5-fold increase of BCR-ABL/ABL clearly predicts presence of BCR-ABL mutations and indicates the exact time for mutation detection performing in patients with suboptimal response and treatment failure. Nowadays, with availability of primary reference material for BCR-ABL quantification, approved by WHO (H. White at al, Hematologica, 2010) and successful harmonization of molecular monitoring of CML therapy (M. Mueller et al, Leukemia 2009) elevation level that corresponds with mutation presence could also be standardized. Application of international standardized threshold level would help to avoid unnecessary or late mutation tests. Disclosures: Ivanets: Novartis Pharma: Employment.

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The use of pooled viral load testing to identify antiretroviral treatment failure

AIDS ◽

10.1097/qad.0b013e3283313ca9 ◽

2009 ◽

Vol 23 (16) ◽

pp. 2151-2158 ◽

Cited By ~ 24

Author(s):

Davey M Smith ◽

Susanne J May ◽

Josué Pérez-Santiago ◽

Matthew C Strain ◽

Caroline C Ignacio ◽

...

Keyword(s):

Viral Load ◽

Treatment Failure ◽

Antiretroviral Treatment ◽

Load Testing ◽

Viral Load Testing ◽

Antiretroviral Treatment Failure

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Acute heart failure: predicting early in-hospital outcomes

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.019 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

M Santos ◽

S Paula ◽

I Almeida ◽

H Santos ◽

H Miranda ◽

...

Keyword(s):

Heart Failure ◽

Logistic Regression ◽

Acute Heart Failure ◽

Roc Curve ◽

Real Life ◽

Study Data ◽

Curve Analysis ◽

Older Age ◽

Invasive Ventilation ◽

Roc Curve Analysis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients (P) with acute heart failure (AHF) are a heterogeneous population. Risk stratification at admission may help predict in-hospital complications and needs. The Get With The Guidelines Heart Failure score (GWTG-HF) predicts in-hospital mortality (M) of P admitted with AHF. ACTION ICU score is validated to estimate the risk of complications requiring ICU care in non-ST elevation acute coronary syndromes. Objective To validate ACTION-ICU score in AHF and to compare ACTION-ICU to GWTG-HF as predictors of in-hospital M (IHM), early M [1-month mortality (1mM)] and 1-month readmission (1mRA), using real-life data. Methods Based on a single-center retrospective study, data collected from P admitted in the Cardiology department with AHF between 2010 and 2017. P without data on previous cardiovascular history or uncompleted clinical data were excluded. Statistical analysis used chi-square, non-parametric tests, logistic regression analysis and ROC curve analysis. Results Among the 300 P admitted with AHF included, mean age was 67.4 ± 12.6 years old and 72.7% were male. Systolic blood pressure (SBP) was 131.2 ± 37.0mmHg, glomerular filtration rate (GFR) was 57.1 ± 23.5ml/min. 35.3% were admitted in Killip-Kimball class (KKC) 4. ACTION-ICU score was 10.4 ± 2.3 and GWTG-HF was 41.7 ± 9.6. Inotropes’ usage was necessary in 32.7% of the P, 11.3% of the P needed non-invasive ventilation (NIV), 8% needed invasive ventilation (IV). IHM rate was 5% and 1mM was 8%. 6.3% of the P were readmitted 1 month after discharge. Older age (p < 0.001), lower SBP (p = 0,035) and need of inotropes (p < 0.001) were predictors of IHM in our population. As expected, patients presenting in KKC 4 had higher IHM (OR 8.13, p < 0.001). Older age (OR 1.06, p = 0.002, CI 1.02-1.10), lower SBP (OR 1.01, p = 0.05, CI 1.00-1.02) and lower left ventricle ejection fraction (LVEF) (OR 1.06, p < 0.001, CI 1.03-1.09) were predictors of need of NIV. None of the variables were predictive of IV. LVEF (OR 0.924, p < 0.001, CI 0.899-0.949), lower SBP (OR 0.80, p < 0.001, CI 0.971-0.988), higher urea (OR 1.01, p < 0.001, CI 1.005-1.018) and lower sodium (OR 0.92, p = 0.002, CI 0.873-0.971) were predictors of inotropes’ usage. Logistic regression showed that GWTG-HF predicted IHM (OR 1.12, p < 0.001, CI 1.05-1.19), 1mM (OR 1.10, p = 1.10, CI 1.04-1.16) and inotropes’s usage (OR 1.06, p < 0.001, CI 1.03-1.10), however it was not predictive of 1mRA, need of IV or NIV. Similarly, ACTION-ICU predicted IHM (OR 1.51, p = 0.02, CI 1.158-1.977), 1mM (OR 1.45, p = 0.002, CI 1.15-1.81) and inotropes’ usage (OR 1.22, p = 0.002, CI 1.08-1.39), but not 1mRA, the need of IV or NIV. ROC curve analysis revealed that GWTG-HF score performed better than ACTION-ICU regarding IHM (AUC 0.774, CI 0.46-0-90 vs AUC 0.731, CI 0.59-0.88) and 1mM (AUC 0.727, CI 0.60-0.85 vs AUC 0.707, CI 0.58-0.84). Conclusion In our population, both scores were able to predict IHM, 1mM and inotropes’s usage.

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Presepsin values and prognostic nutritional index predict mortality in intensive care unit patients with sepsis: a pilot study

BMC Research Notes ◽

10.1186/s13104-021-05659-9 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Yuichiro Shimoyama ◽

Osamu Umegaki ◽

Noriko Kadono ◽

Toshiaki Minami

Keyword(s):

Multivariate Analysis ◽

Roc Curve ◽

Operating Characteristic ◽

Prognostic Nutritional Index ◽

Early Mortality ◽

Curve Analysis ◽

Rank Test ◽

Roc Curve Analysis ◽

Log Rank Test ◽

Nutritional Index

Abstract Objective Sepsis is a major cause of mortality for critically ill patients. This study aimed to determine whether presepsin values can predict mortality in patients with sepsis. Results Receiver operating characteristic (ROC) curve analysis, Log-rank test, and multivariate analysis identified presepsin values and Prognostic Nutritional Index as predictors of mortality in sepsis patients. Presepsin value on Day 1 was a predictor of early mortality, i.e., death within 7 days of ICU admission; ROC curve analysis revealed an AUC of 0.84, sensitivity of 89%, and specificity of 77%; and multivariate analysis showed an OR of 1.0007, with a 95%CI of 1.0001–1.0013 (p = 0.0320).

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Soluble cytotoxic T-lymphocyte–associated antigen 4 (sCTLA-4) as a potential biomarker for diagnosis and evaluation of the prognosis in Glioma

BMC Immunology ◽

10.1186/s12865-021-00422-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jiajia Liu ◽

Xiaoyi Tian ◽

Yan Wang ◽

Xixiong Kang ◽

Wenqi Song

Keyword(s):

T Lymphocyte ◽

Roc Curve ◽

Cytotoxic T Lymphocyte ◽

Tumor Grade ◽

Curve Analysis ◽

Enzyme Linked Immunosorbent Assay ◽

Low Grade ◽

High Grade ◽

Healthy Individuals ◽

Roc Curve Analysis

Abstract Background The cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) is widely considered as a pivotal immune checkpoint molecule to suppress antitumor immunity. However, the significance of soluble CTLA-4 (sCTLA-4) remains unclear in the patients with brain glioma. Here we aimed to investigate the significance of serum sCTLA-4 levels as a noninvasive biomarker for diagnosis and evaluation of the prognosis in glioma patients. Methods In this study, the levels of sCTLA-4 in serum from 50 patients diagnosed with different grade gliomas including preoperative and postoperative, and 50 healthy individuals were measured by an enzyme-linked immunosorbent assay (ELISA). And then ROC curve analysis and survival analyses were performed to explore the clinical significance of sCTLA-4. Results Serum sCTLA-4 levels were significantly increased in patients with glioma compared to that of healthy individuals, and which was also positively correlated with the tumor grade. ROC curve analysis showed that the best cutoff value for sCTLA-4 for glioma is 112.1 pg/ml, as well as the sensitivity and specificity with 82.0 and 78.0%, respectively, and a cut-off value of 220.43 pg/ml was best distinguished in patients between low-grade glioma group and high-grade glioma group with sensitivity 73.1% and specificity 79.2%. Survival analysis revealed that the patients with high sCTLA-4 levels (> 189.64 pg/ml) had shorter progression-free survival (PFS) compared to those with low sCTLA-4 levels (≤189.64 pg/ml). In the univariate analysis, elder, high-grade tumor, high sCTLA-4 levels and high Ki-67 index were significantly associated with shorter PFS. In the multivariate analysis, sCTLA-4 levels and tumor grade remained an independent prognostic factor. Conclusion These findings indicated that serum sCTLA-4 levels play a critical role in the pathogenesis and development of glioma, which might become a valuable predictive biomarker for supplementary diagnosis and evaluation of the progress and prognosis in glioma.

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Predictive CT features for the diagnosis of primary pulmonary mucoepidermoid carcinoma: comparison with squamous cell carcinomas and adenocarcinomas

Cancer Imaging ◽

10.1186/s40644-020-00375-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaohua Ban ◽

Xinping Shen ◽

Huijun Hu ◽

Rong Zhang ◽

Chuanmiao Xie ◽

...

Keyword(s):

Logistic Regression ◽

Roc Curve ◽

Multinomial Logistic Regression ◽

Univariate Analysis ◽

Ct Imaging ◽

Squamous Cell Carcinomas ◽

Curve Analysis ◽

Imaging Features ◽

Roc Curve Analysis ◽

Ct Features

Abstract Background To determine the predictive CT imaging features for diagnosis in patients with primary pulmonary mucoepidermoid carcinomas (PMECs). Materials and methods CT imaging features of 37 patients with primary PMECs, 76 with squamous cell carcinomas (SCCs) and 78 with adenocarcinomas were retrospectively reviewed. The difference of CT features among the PMECs, SCCs and adenocarcinomas was analyzed using univariate analysis, followed by multinomial logistic regression and receiver operating characteristic (ROC) curve analysis. Results CT imaging features including tumor size, location, margin, shape, necrosis and degree of enhancement were significant different among the PMECs, SCCs and adenocarcinomas, as determined by univariate analysis (P < 0.05). Only lesion location, shape, margin and degree of enhancement remained independent factors in multinomial logistic regression analysis. ROC curve analysis showed that the area under curve of the obtained multinomial logistic regression model was 0.805 (95%CI: 0.704–0.906). Conclusion The prediction model derived from location, margin, shape and degree of enhancement can be used for preoperative diagnosis of PMECs.

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