Conference Material > Poster
Doherty M, Richardson K, Lynch-Godrei A, Azad TB, Ferdous L, et al.
MSF Paediatric Days 2022. 2021 November 30; DOI:10.57740/k0d5-c989
Journal Article > CommentaryFull Text
PLOS Med. 2020 February 14; Volume 17 (Issue 2); e1003028.; DOI:10.1371/journal.pmed.1003028.
Ford NP, Geng EH, Ellman T, Orrell C, Ehrenkranz PD, et al.
PLOS Med. 2020 February 14; Volume 17 (Issue 2); e1003028.; DOI:10.1371/journal.pmed.1003028.
Journal Article > ResearchFull Text
AIDS. 2019 October 1; Volume 33 (Issue 12); 1881-1889.; DOI:10.1097/QAD.0000000000002303
Sacks JA, Fong Y, Gonzalez MP, Andreotti M, Baliga S, et al.
AIDS. 2019 October 1; Volume 33 (Issue 12); 1881-1889.; DOI:10.1097/QAD.0000000000002303
BACKGROUND
Coverage of viral load testing remains low with only half of the patients in need having adequate access. Alternative technologies to high throughput centralized machines can be used to support viral load scale-up; however, clinical performance data are lacking. We conducted a meta-analysis comparing the Cepheid Xpert HIV-1 viral load plasma assay to traditional laboratory-based technologies.
METHODS
Cepheid Xpert HIV-1 and comparator laboratory technology plasma viral load results were provided from 13 of the 19 eligible studies, which accounted for a total of 3790 paired data points. We used random effects models to determine the accuracy and misclassification at various treatment failure thresholds (detectable, 200, 400, 500, 600, 800 and 1000 copies/ml).
RESULTS
Thirty percent of viral load test results were undetectable, while 45% were between detectable and 10 000 copies/ml and the remaining 25% were above 10 000 copies/ml. The median Xpert viral load was 119 copies/ml and the median comparator viral load was 157 copies/ml, while the log10 bias was 0.04 (0.02–0.07). The sensitivity and specificity to detect treatment failure were above 95% at all treatment failure thresholds, except for detectable, at which the sensitivity was 93.33% (95% confidence interval: 88.2–96.3) and specificity was 80.56% (95% CI: 64.6–90.4).
CONCLUSION
The Cepheid Xpert HIV-1 viral load plasma assay results were highly comparable to laboratory-based technologies with limited bias and high sensitivity and specificity to detect treatment failure. Alternative specimen types and technologies that enable decentralized testing services can be considered to expand access to viral load.
Coverage of viral load testing remains low with only half of the patients in need having adequate access. Alternative technologies to high throughput centralized machines can be used to support viral load scale-up; however, clinical performance data are lacking. We conducted a meta-analysis comparing the Cepheid Xpert HIV-1 viral load plasma assay to traditional laboratory-based technologies.
METHODS
Cepheid Xpert HIV-1 and comparator laboratory technology plasma viral load results were provided from 13 of the 19 eligible studies, which accounted for a total of 3790 paired data points. We used random effects models to determine the accuracy and misclassification at various treatment failure thresholds (detectable, 200, 400, 500, 600, 800 and 1000 copies/ml).
RESULTS
Thirty percent of viral load test results were undetectable, while 45% were between detectable and 10 000 copies/ml and the remaining 25% were above 10 000 copies/ml. The median Xpert viral load was 119 copies/ml and the median comparator viral load was 157 copies/ml, while the log10 bias was 0.04 (0.02–0.07). The sensitivity and specificity to detect treatment failure were above 95% at all treatment failure thresholds, except for detectable, at which the sensitivity was 93.33% (95% confidence interval: 88.2–96.3) and specificity was 80.56% (95% CI: 64.6–90.4).
CONCLUSION
The Cepheid Xpert HIV-1 viral load plasma assay results were highly comparable to laboratory-based technologies with limited bias and high sensitivity and specificity to detect treatment failure. Alternative specimen types and technologies that enable decentralized testing services can be considered to expand access to viral load.
Journal Article > Meta-AnalysisFull Text
Lancet HIV. 2015 August 11; Volume 2 (Issue 10); DOI:10.1016/S2352-3018(15)00137-X
Ford NP, Shubber Z, Meintjes GA, Grinsztejn B, Eholie SP, et al.
Lancet HIV. 2015 August 11; Volume 2 (Issue 10); DOI:10.1016/S2352-3018(15)00137-X
Journal Article > CommentaryAbstract
Lancet Infect Dis. 2014 November 19; Volume 15 (Issue 2); DOI:10.1016/S1473-3099(14)70896-5
Ford NP, Meintjes GA, Pozniak A, Bygrave H, Hill AM, et al.
Lancet Infect Dis. 2014 November 19; Volume 15 (Issue 2); DOI:10.1016/S1473-3099(14)70896-5
For more than two decades, CD4 cell count measurements have been central to understanding HIV disease progression, making important clinical decisions, and monitoring the response to antiretroviral therapy (ART). In well resourced settings, the monitoring of patients on ART has been supported by routine virological monitoring. Viral load monitoring was recommended by WHO in 2013 guidelines as the preferred way to monitor people on ART, and efforts are underway to scale up access in resource-limited settings. Recent studies suggest that in situations where viral load is available and patients are virologically suppressed, long-term CD4 monitoring adds little value and stopping CD4 monitoring will have major cost savings. CD4 cell counts will continue to play an important part in initial decisions around ART initiation and clinical management, particularly for patients presenting late to care, and for treatment monitoring where viral load monitoring is restricted. However, in settings where both CD4 cell counts and viral load testing are routinely available, countries should consider reducing the frequency of CD4 cell counts or not doing routine CD4 monitoring for patients who are stable on ART.
Journal Article > Meta-AnalysisAbstract
AIDS. 2019 October 1; DOI:10.1097/QAD.0000000000002303.
Sacks JA, Fong Y, Gonzalez MP, Andreotti M, Baliga S, et al.
AIDS. 2019 October 1; DOI:10.1097/QAD.0000000000002303.
Journal Article > CommentaryFull Text
Lancet Infect Dis. 2018 October 18; Volume 19 (Issue 4); DOI:10.1016/S1473-3099(18)30493-6
Loyse A, Burry J, Cohn J, Ford NP, Chiller T, et al.
Lancet Infect Dis. 2018 October 18; Volume 19 (Issue 4); DOI:10.1016/S1473-3099(18)30493-6
In 2018, WHO issued guidelines for the diagnosis, prevention, and management of HIV-related cryptococcal disease. Two strategies are recommended to reduce the high mortality associated with HIV-related cryptococcal meningitis in low-income and middle-income countries (LMICs): optimised combination therapies for confirmed meningitis cases and cryptococcal antigen screening programmes for ambulatory people living with HIV who access care. WHO's preferred therapy for the treatment of HIV-related cryptococcal meningitis in LMICs is 1 week of amphotericin B plus flucytosine, and the alternative therapy is 2 weeks of fluconazole plus flucytosine. In the ACTA trial, 1-week (short course) amphotericin B plus flucytosine resulted in a 10-week mortality of 24% (95% CI -16 to 32) and 2 weeks of fluconazole and flucytosine resulted in a 10-week mortality of 35% (95% CI -29 to 41). However, with widely used fluconazole monotherapy, mortality because of HIV-related cryptococcal meningitis is approximately 70% in many African LMIC settings. Therefore, the potential to transform the management of HIV-related cryptococcal meningitis in resource-limited settings is substantial. Sustainable access to essential medicines, including flucytosine and amphotericin B, in LMICs is paramount and the focus of this Personal View.
Conference Material > Poster
Blatman Z, Doherty M, Richardson K, Yantzi R, Rayala S
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/TbIQJgT
Conference Material > Poster
Doherty M, Richardson K, Luraschi D
MSF Paediatric Days 2022. 2022 November 30; DOI:10.57740/b9zg-kp07
Journal Article > CommentaryFull Text
J Int AIDS Soc. 2016 December 1; Volume 19 (Issue 1); 21484.; DOI:10.7448/IAS.19.1.21484
Grimsrud A, Bygrave H, Doherty M, Ehrenkranz PD, Ellman T, et al.
J Int AIDS Soc. 2016 December 1; Volume 19 (Issue 1); 21484.; DOI:10.7448/IAS.19.1.21484