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Anthropometric and immunological success of antiretroviral therapy and prediction of virological success in west African adults.: Predictors of virological success of ART in Abidjan

Abstract : OBJECTIVE: The 6 month assessment of the response to antiretroviral therapy (ART) is a critical step. In sub-Saharan Africa, few people have access to plasma viral-load measurement. We assessed the gain or loss in body mass index (BMI), alone or in combination with the gain or loss in CD4+ T-cell count (CD4), as a tool for predicting the response to ART. METHODS: In a cohort of 622 adults in Abidjan, C?d'Ivoire, we calculated the sensitivity, specificity and predictive values of BMI and CD4 for treatment success defined as viral-load undetectability (< 300 copies/ml) as gold standard. FINDINGS: After 6 months of ART, the median change in BMI was an increase of 1.0 kg/m(2) (interquartile range, IQR: 0.0-2.1), the median change in CD4 an increase of 148/ml (IQR: 54-230) and 84% of patients reached viral-load undetectability. The distribution of change in BMI was similar among patients who reached undetectability and those who did not (increases of 1.06 kg/m(2) versus 0.99 kg/m(2), P = 0.51). With larger changes in BMI, the specificity for treatment success increased but its sensitivity decreased and its positive predictive value was stable around 85%. All results remained similar when combining changes in BMI with those in CD4 and when stratifying by groups of baseline BMI or CD4. CONCLUSION: In settings where viral-load measurement is not available, a high BMI gain does not reflect virological success, even when combined with a high CD4 gain. In our population, most patients with detectable viral-load had probably adhered to the drug regimen sufficiently to reach significant gains in body mass and CD4 count but had adhered insufficiently to reach viral suppression.
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Submitted on : Monday, June 30, 2008 - 10:41:36 AM
Last modification on : Monday, April 20, 2020 - 1:02:02 PM
Long-term archiving on: : Thursday, May 20, 2010 - 10:26:45 PM

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  • HAL Id : inserm-00266573, version 1
  • PUBMED : 18568272

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Eugène Messou, Delphine Gabillard, Raoul Moh, André Inwoley, Souleymane Sorho, et al.. Anthropometric and immunological success of antiretroviral therapy and prediction of virological success in west African adults.: Predictors of virological success of ART in Abidjan. Bulletin of the World Health Organization, World Health Organization, 2008, 86 (6), pp.435-42. ⟨inserm-00266573⟩

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