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. 2023 Jul 1;93(3):244-250.
doi: 10.1097/QAI.0000000000003196.

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

Johannes Thorman  1   2 , Per Björkman  1   3 , Sviataslau Sasinovich  4 , Fregenet Tesfaye  1   5 , Daba Mulleta  6 , Patrik Medstrand  4 , Anton Reepalu  1   3
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Performance of Galectin-9 for Identification of HIV Viremia in Adults Receiving Antiretroviral Therapy in a Resource-Limited Setting

Johannes Thorman et al. J Acquir Immune Defic Syndr. .

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 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 (r s = 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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Conflict of interest statement

No conflicts of interest to disclose. J.T. received funding from Region Skåne (regional research grant). P.B. received funding from the Swedish State (under the agreement between Swedish government and the county councils, the ALF agreement), Region Skåne (regional research grant), and through a private donation to Lund University. A.R. received funding from Kungliga Fysiografiska Sällskapet, Lund, Sweden, and from the SUS Foundation, Malmö, Sweden. P.M. received funding from the Swedish Research Council and through a donation to Lund University.

References

    1. WHO | Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection. Available from: https://www.who.int/hiv/pub/arv/arv-2016/en/ . Accessed April 7, 2021.
    1. Cohen MS, Chen YQ, McCauley M, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med. 2016;375:830–839.
    1. Boeke CE, Joseph J, Atem C, et al. Evaluation of near point-of-care viral load implementation in public health facilities across seven countries in sub-Saharan Africa. J Int AIDS Soc. 2021;24:e25663.
    1. Meya D, Spacek La, Tibenderana H, et al. Development and evaluation of a clinical algorithm to monitor patients on antiretrovirals in resource-limited settings using adherence, clinical and CD4 cell count criteria. J Int AIDS Soc. 2009;12:3.
    1. Abouyannis M, Menten J, Kiragga A, et al. Development and validation of systems for rational use of viral load testing in adults receiving first-line ART in sub-Saharan Africa. Aids. 2011;25:1627–1635.

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