HIV Virologic Failure for an HIV Outpatient - Medical Algorithm

Description

Robbins et al develop a simple score to identify an HIV-positive outpatient who is likely to experience virologic failure. This can helpt to identify a patient who may require more aggressive management. The authors are from Massachusetts General Hospital and Brigham and Women's Hospital in Boston.

Parameters:

(1) adherence

(2) CD4 cell count

(3) drug and/or alcohol abuse

(4) experience with HAART (highly-active antiretroviral therapy)

(5) number of appointments missed within the past year

(6) history of virologic failure

(7) duration of HIV suppression

Parameter	Finding	Points
adherence	optimum	0
	suboptimum (< 85%)	1
CD4 cell count	>= 100 per µL	0
	< 100 per µL	1
drug and/or alcohol abuse	no	0
	yes	1
experienced with HAART	no	0
	yes	1
number of appointments missed	0	0
	>= 1	1
history of virologic failure	no	0
	yes	1
duration of viral suppression	>= 12 months	0
	< 12 months	1

where:

• Experenced with HAART: (treatment with NRTI, non-NRTI and protease inhibitor prior to current regimen) OR (current antiretroviral therapy regimen containing enfuvirtide or an investigational antiretroviral drug)

• The abstract uses <= 12 months for duration of viral suppression while Table 3 uses < 12 months.

total score =

= SUM(points for all 7 paramters)

Interpretation:

• minimum score: 0

• maximum score: 7

• The higher the score the greater the risk of virologic failure.

Total Score	Risk for Virologic Failure
0 or 1	low
2 or 3	intermediate
4 to 7	high

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Description

Specialty

Objective

ICD-10

Risk Score of Robbins et al for Predicting Virologic Failure for an HIV Outpatient

Purpose: To identify an HIV-positive outpatient who is at risk for virologic failure using the risk score of Robbins et al.

Description

Specialty

Objective

ICD-10