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Performance of Galectin-9 for Identification of HIV Viremia in Adults Receiving Antiretroviral Therapy in a Resource-Limited Setting

Thorman, Johannes LU ; Björkman, Per LU orcid ; Sasinovich, Sviataslau LU ; Tesfaye, Fregenet ; Mulleta, Daba ; Medstrand, Patrik LU orcid and Reepalu, Anton LU orcid (2023) In Journal of Acquired Immune Deficiency Syndromes 93(3). p.244-250
Abstract

Background: Targeted viral load (VL) testing has been proposed for antiretroviral treatment (ART) monitoring in resource-limited settings. In this study, we have investigated the performance of the host biomarker galectin-9 (Gal-9), alone and in combination with interferon-γ-inducible protein 10 (IP-10), in identifying individuals at increased likelihood of viremia during ART.Setting:Cohort of HIV-positive adults receiving ART at Ethiopian health centers.Methods:We included participants with detectable viremia (VL ≥150 copies/mL) 12 months after starting ART and sex-matched nonviremic controls. Performance to identify individuals with VL ≥1000 copies/mL was determined for Gal-9 and the Gal-9/IP-10 combination, respectively, using... (More)

Background: Targeted viral load (VL) testing has been proposed for antiretroviral treatment (ART) monitoring in resource-limited settings. In this study, we have investigated the performance of the host biomarker galectin-9 (Gal-9), alone and in combination with interferon-γ-inducible protein 10 (IP-10), in identifying individuals at increased likelihood of viremia during ART.Setting:Cohort of HIV-positive adults receiving ART at Ethiopian health centers.Methods:We included participants with detectable viremia (VL ≥150 copies/mL) 12 months after starting ART and sex-matched nonviremic controls. Performance to identify individuals with VL ≥1000 copies/mL was determined for Gal-9 and the Gal-9/IP-10 combination, respectively, using receiver operating characteristic (ROC) analysis.Results:Among 191 participants (50.3% women), 46 (24.1%) had VL ≥1000 copies/mL, 23 (12.0%) had 150-999 copies/mL, and 122 (63.9%) had <150 copies/mL. Gal-9 and VL were positively correlated (rs= 0.451, P < 0.001). Sensitivity and specificity for Gal-9 to identify individuals with VL ≥1000 copies/mL were 91.3% (95% CI: 79.2-97.6) and 54.5% (95% CI: 46.0-62.8), respectively. The area under the ROC curve for Gal-9 was 0.810 (95% CI: 0.745-0.875), which was similar to that of the combination of Gal-9 and IP-10 [0.849 (95% CI: 0.792-0.905)]. Assuming 10% prevalence of VL ≥1000 copies/mL, using Gal-9 for targeted VL testing instead of universal VL testing would reduce the number of VL tests from 10 to 5 to identify 1 viremic individual, with misclassification of 1 in 10 viremic individuals.Conclusions:Gal-9 is a potential screening marker for targeted VL monitoring in ART recipients. Further studies are needed to determine optimal threshold levels.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
antiretroviral treatment, galectin-9, HIV, interferon-γ-inducible protein 10, screening marker, viral load
in
Journal of Acquired Immune Deficiency Syndromes
volume
93
issue
3
pages
7 pages
publisher
Lippincott Williams & Wilkins
external identifiers
  • pmid:36961948
  • scopus:85163189937
ISSN
1525-4135
DOI
10.1097/QAI.0000000000003196
language
English
LU publication?
yes
id
d63c039a-8106-4fba-b17b-1e707e2dd60f
date added to LUP
2023-09-13 12:26:02
date last changed
2024-04-20 03:12:32
@article{d63c039a-8106-4fba-b17b-1e707e2dd60f,
  abstract     = {{<p>Background: Targeted viral load (VL) testing has been proposed for antiretroviral treatment (ART) monitoring in resource-limited settings. In this study, we have investigated the performance of the host biomarker galectin-9 (Gal-9), alone and in combination with interferon-γ-inducible protein 10 (IP-10), in identifying individuals at increased likelihood of viremia during ART.Setting:Cohort of HIV-positive adults receiving ART at Ethiopian health centers.Methods:We included participants with detectable viremia (VL ≥150 copies/mL) 12 months after starting ART and sex-matched nonviremic controls. Performance to identify individuals with VL ≥1000 copies/mL was determined for Gal-9 and the Gal-9/IP-10 combination, respectively, using receiver operating characteristic (ROC) analysis.Results:Among 191 participants (50.3% women), 46 (24.1%) had VL ≥1000 copies/mL, 23 (12.0%) had 150-999 copies/mL, and 122 (63.9%) had &lt;150 copies/mL. Gal-9 and VL were positively correlated (r<sub>s</sub>= 0.451, P &lt; 0.001). Sensitivity and specificity for Gal-9 to identify individuals with VL ≥1000 copies/mL were 91.3% (95% CI: 79.2-97.6) and 54.5% (95% CI: 46.0-62.8), respectively. The area under the ROC curve for Gal-9 was 0.810 (95% CI: 0.745-0.875), which was similar to that of the combination of Gal-9 and IP-10 [0.849 (95% CI: 0.792-0.905)]. Assuming 10% prevalence of VL ≥1000 copies/mL, using Gal-9 for targeted VL testing instead of universal VL testing would reduce the number of VL tests from 10 to 5 to identify 1 viremic individual, with misclassification of 1 in 10 viremic individuals.Conclusions:Gal-9 is a potential screening marker for targeted VL monitoring in ART recipients. Further studies are needed to determine optimal threshold levels.</p>}},
  author       = {{Thorman, Johannes and Björkman, Per and Sasinovich, Sviataslau and Tesfaye, Fregenet and Mulleta, Daba and Medstrand, Patrik and Reepalu, Anton}},
  issn         = {{1525-4135}},
  keywords     = {{antiretroviral treatment; galectin-9; HIV; interferon-γ-inducible protein 10; screening marker; viral load}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{244--250}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Journal of Acquired Immune Deficiency Syndromes}},
  title        = {{Performance of Galectin-9 for Identification of HIV Viremia in Adults Receiving Antiretroviral Therapy in a Resource-Limited Setting}},
  url          = {{http://dx.doi.org/10.1097/QAI.0000000000003196}},
  doi          = {{10.1097/QAI.0000000000003196}},
  volume       = {{93}},
  year         = {{2023}},
}