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Misdiagnosis of HIV treatment failure based on clinical and immunological criteria in Eastern and Central Kenya

Overview of attention for article published in BMC Infectious Diseases, June 2017
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2 tweeters

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4 Dimensions

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25 Mendeley
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Title
Misdiagnosis of HIV treatment failure based on clinical and immunological criteria in Eastern and Central Kenya
Published in
BMC Infectious Diseases, June 2017
DOI 10.1186/s12879-017-2487-5
Pubmed ID
Authors

Sunguti Luke Joram, Gathii Paul, Kitheka Moses, Bii Stanley, Malonza Isaac, Gohole Allan, Marwa Tom, Karimi Lilian, Mudany Mildred

Abstract

Routine laboratory monitoring is part of the basic care package offered to people living with the Human Immunodeficiency Virus (PLHIV). This paper aims to identify the proportion of PLHIVs with clinical and immunological failure who are virologically suppressed and risk being misclassified as treatment failures. A retrospective analysis of patient viral load data collected between January 2013 and June 2014 was conducted. Of the patients classified as experiencing either clinical or immunological failure, we evaluated the proportion of true (virological) failure, and estimated the sensitivity and specificity of the immunological and clinical criteria in diagnosing true treatment failure. Of the 27,418 PLHIVs aged 2-80 years on ART in the study period, 6.8% (n = 1859) were suspected of treatment failure and their viral loads analysed. 40% (n = 737) demonstrated viral suppression (VL < 1000 copies/ml). The median viral load (VL) was 3317 copies/ml (IQR 0-47,547). Among the 799 (2.9%) PLHIVs on ART classified as having clinical failure, 41.1% (n = 328) of them had confirmed viral suppression. Of the 463 (1.7%) classified as having immunological failure, 36.9% (n = 171) had confirmed viral suppression. The sensitivity of the clinical criteria in diagnosing true failure was 61% (CI 58%-65%) while that of the immunological criteria 38% (CI 35%-42%). The specificity of the clinical criteria was 34% (CI 30%-39%) while that of the immunological criteria 66% (61%-70%). Age below 20 years was associated with a high viral load (p < .001). Sex and ART regimen were not associated with the viral load. Clinical and immunological criteria alone are not sufficient to identify true treatment failure. There is need for accurate treatment failure diagnosis through viral load testing to avoid incorrect early or delayed switching of patients to second-line regimens. This study recommends increased viral load testing in line with the Kenya's ART guidelines.

Twitter Demographics

The data shown below were collected from the profiles of 2 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 25 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 25 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 7 28%
Researcher 5 20%
Student > Postgraduate 3 12%
Unspecified 3 12%
Student > Bachelor 3 12%
Other 4 16%
Readers by discipline Count As %
Medicine and Dentistry 8 32%
Unspecified 4 16%
Nursing and Health Professions 4 16%
Immunology and Microbiology 4 16%
Environmental Science 1 4%
Other 4 16%

Attention Score in Context

This research output has an Altmetric Attention Score of 2. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 02 August 2017.
All research outputs
#6,911,495
of 11,553,067 outputs
Outputs from BMC Infectious Diseases
#2,173
of 4,293 outputs
Outputs of similar age
#140,553
of 270,703 outputs
Outputs of similar age from BMC Infectious Diseases
#47
of 105 outputs
Altmetric has tracked 11,553,067 research outputs across all sources so far. This one is in the 37th percentile – i.e., 37% of other outputs scored the same or lower than it.
So far Altmetric has tracked 4,293 research outputs from this source. They receive a mean Attention Score of 4.2. This one is in the 44th percentile – i.e., 44% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 270,703 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 44th percentile – i.e., 44% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 105 others from the same source and published within six weeks on either side of this one. This one is in the 48th percentile – i.e., 48% of its contemporaries scored the same or lower than it.