Prioritizing CD4 Count Monitoring in Response to ART in Resource-Constrained Settings A Retrospective Application of Prediction-Based Classification 英文参考文献.docVIP

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Prioritizing CD4 Count Monitoring in Response to ART in Resource-Constrained Settings A Retrospective Application of Prediction-Based Classification 英文参考文献.doc

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Prioritizing CD4 Count Monitoring in Response to ART in Resource-Constrained Settings A Retrospective Application of Prediction-Based Classification 英文参考文献

PrioritizingCD4CountMonitoringinResponsetoARTin Resource-ConstrainedSettings:ARetrospective ApplicationofPrediction-BasedClassification LivioAzzoni1.,AndreaS.Foulkes2.,YanLiu2,XiaohongLi3,MargaretJohnson4,ColletteSmith5 ,Adeeba bteKamarulzaman6,JulioMontaner7,KaramMounzer8,MichaelSaag9,PedroCahn10,CarinaCesar10, AlejandroKrolewiecki10,IanSanne11,LuisJ.Montaner1* 1WistarInstitute,Philadelphia,Pennsylvania,UnitedStatesofAmerica,2UniversityofMassachusetts,Amherst,Massachusetts,UnitedStatesofAmerica,3BGMedicine, Waltham, Massachusetts, United States of America, 4Royal Free Hampstead NHS Trust, London, United Kingdom, 5UCL Medical School, London, United Kingdom, 6UniversityofMalaya,KualaLumpur,Malaysia,7UniversityofBritishColumbia,Vancouver,BritishColumbia,Canada,8PhiladelphiaFIGHT,Philadelphia,Pennsylvania, UnitedStatesofAmerica,9UniversityofAlabama,Tuscaloosa,Alabama,UnitedStatesofAmerica,10Fundacio′nHue′sped,BuenosAires,Argentina,11Universityofthe Witwatersrand,Johannesburg,SouthAfrica Abstract Background:Globalprogramsofanti-HIVtreatmentdependonsustainedlaboratorycapacitytoassesstreatmentinitiation thresholdsandtreatmentresponseovertime.Currently,thereisnovalidalternativetoCD4counttestingformonitoring immunologicresponsestotreatment,butlaboratorycostandcapacitylimitaccesstoCD4testinginresource-constrained settings. Thus, methods to prioritize patients for CD4 count testing could improve treatment monitoring by optimizing resourceallocation. Methods and Findings: Using a prospective cohort of HIV-infected patients (n=1,956) monitored upon antiretroviral therapyinitiationinsevenclinicalsiteswithdistinctgeographicalandsocio-economicsettings,weretrospectivelyapplya novel prediction-based classification (PBC) modeling method. The model uses repeatedly measured biomarkers (white + bloodcellcountandlymphocytepercent)topredictCD4 Tcelloutcomethroughfirst-stagemodelingandsubsequent classification based on clinically relevant thresholds (CD4+ T cell count of 200 or 350