Davies, Mary-AnnMary-AnnDaviesBoulle, AndrewAndrewBoulleTechnau, KarlKarlTechnauEley, BrianBrianEleyMoultrie, HarryHarryMoultrieRabie, HelenaHelenaRabieGarone, DanielaDanielaGaroneGiddy, JanetJanetGiddyWood, RobinRobinWoodEgger, MatthiasMatthiasEgger0000-0001-7462-5132Keiser, OliviaOliviaKeiser0000-0001-8191-2789IeDEA, Southern Africa CollaborationSouthern Africa CollaborationIeDEA2024-10-112024-10-112012https://boris-portal.unibe.ch/handle/20.500.12422/84023Objectives  To determine the improvement in positive predictive value of immunological failure criteria for identifying virological failure in HIV-infected children on antiretroviral therapy (ART) when a single targeted viral load measurement is performed in children identified as having immunological failure. Methods  Analysis of data from children (<16 years at ART initiation) at South African ART sites at which CD4 count/per cent and HIV-RNA monitoring are performed 6-monthly. Immunological failure was defined according to both WHO 2010 and United States Department of Health and Human Services (DHHS) 2008 criteria. Confirmed virological failure was defined as HIV-RNA >5000 copies/ml on two consecutive occasions <365 days apart in a child on ART for ≥18 months. Results  Among 2798 children on ART for ≥18 months [median (IQR) age 50 (21-84) months at ART initiation], the cumulative probability of confirmed virological failure by 42 months on ART was 6.3%. Using targeted viral load after meeting DHHS immunological failure criteria rather than DHHS immunological failure criteria alone increased positive predictive value from 28% to 82%. Targeted viral load improved the positive predictive value of WHO 2010 criteria for identifying confirmed virological failure from 49% to 82%. Conclusion  The addition of a single viral load measurement in children identified as failing immunologically will prevent most switches to second-line treatment in virologically suppressed children.en600 - Technology::610 - Medicine & health300 - Social sciences, sociology & anthropology::360 - Social problems & social servicesarticle10.7892/boris.139532297434500031002840001110.1111/j.1365-3156.2012.03073.x