Detection In Clinical Practice Research Articles

Accuracy of brain amyloid detection in clinical practice using cerebrospinal fluid β-amyloid 42: a cross-validation study against amyloid positron emission tomography.

Before adding cerebrospinal fluid (CSF) biomarkers to the diagnostic workup of Alzheimer disease, it needs to be determined whether CSF biomarkers analyzed in routine clinical practice can reliably predict cortical β-amyloid (Aβ) deposition. To study whether CSF biomarkers, analyzed consecutively in routine clinical practice during 2 years, can predict cortical Aβ deposition and to establish a threshold for Aβ42 abnormality. This cross-sectional study (The Swedish BioFINDER [Biomarkers For Identifying Neurodegenerative Disorders Early and Reliably] Study) was conducted at 3 memory clinics. It involved consecutively referred, nondemented patients with mild cognitive symptoms (original cohort, n = 118; validation cohort, n = 38). Amyloid positron emission tomography imaging with 18F-flutemetamol. Analyses of CSF Aβ42, total tau, and phosphorylated tau using an enzyme-linked immunosorbent assay (INNOTEST) in clinical samples. The agreement between Aβ classification with CSF Aβ42 and 18F-flutemetamol positron emission tomography was very high (κ = 0.85). Of all the cases, 92% were classified identically using an Aβ42 cutoff of 647 pg/mL or less. Cerebrospinal fluid Aβ42 predicted abnormal cortical Aβ deposition accurately (odds ratio, 165; 95% CI, 39-693; area under the receiver operating characteristic curve, 0.94; 95% CI, 0.88-0.97). The association was independent of age, sex, APOE (apolipoprotein E) genotype, hippocampal volume, memory, and global cognition (adjusted odds ratio, 169; 95% CI, 25-1143). Using ratios of CSF Aβ42:tau or Aβ42:phosphorylated tau did not improve the prediction of Aβ deposition. Cerebrospinal fluid Aβ42 correlated significantly with Aβ deposition in all cortical regions. The highest correlations were in regions with high 18F-flutemetamol retention (eg, posterior cingulum and precuneus, r = -0.72). 18F-flutemetamol retention, but not CSF Aβ42, correlated significantly with global cognition (r = -0.32), memory function (r = -0.28), and hippocampal volume (r = -0.36) among those with abnormal Aβ deposition. Finally, the CSF Aβ42 cutoff derived from the original cohort (≤647 pg/mL) had an equally high agreement (95%; κ = 0.89) with 18F-flutemetamol positron emission tomography in the validation cohort. Cerebrospinal fluid Aβ42 analyzed consecutively in routine clinical practice at an accredited laboratory can be used with high accuracy to determine whether a patient has normal or increased cortical Aβ deposition and so can be valuable for the early diagnosis of Alzheimer disease. Abnormal 18F-flutemetamol retention levels correlate with disease stage in patients with mild cognitive symptoms, but this is not the case for CSF Aβ42 measurements.

Evaluation of Visual Field Progression in Glaucoma

Detection of visual field progression is of critical importance in the management of patients with glaucoma; however, there is no agreed upon set of criteria for the definition of progression. The most commonly utilized method of progression detection in clinical practice may be subjective assessment of serial visual fields. Event-based and trend-based approaches to the analysis of serial visual field data are quite powerful and used in clinical practice and in clinical research. Recent advances in analysis of visual field progression are discussed in this review article.

SAT0511 Achieving Consensus in Ultrasonography Synovitis Scoring in Rheumatoid Arthritis

BackgroundUltrasonography (US) is a sensitive method for synovitis detection in clinical practice but interobserver variation in both acquisition and image intepretation is still a key concern [1]. Various semiquantitative synovitis...

Abstract WMP110: Effectiveness of EEG Ischemia Monitoring in Clinical Practice for the Detection of Delayed Cerebral Ischemia after Subarachnoid Hemorrhage

Background: Quantitative EEG trend monitoring has shown high sensitivity in pilot studies for early detection of delayed cerebral ischemia (DCI) after aneurysmal SAH. Little is understood, however, about its performance in the prospective clinical environment. We hypothesized that clinical confounders and mimics of ischemic EEG patterns may result in high false alarm rates. Methods: Patients undergoing EEG ischemia monitoring within 4 days of SAH were identified from a prospectively documented clinical database and evaluated for any EEG ischemic signs (EEG-IS) denoted by the clinical neurophysiologist (NPhys-EEG-IS), including deterioration by one grade in percent alpha variability (PAV) over 8 hours, >50% decrement in alpha-delta ratio (ADR) exceeding 1 hour, >10% decrement in ADR exceeding 5 hours, or new focal EEG slowing on the raw EEG. We separately performed a wholly computational retrospective assessment for EEG-IS (Comp-EEG-IS). DCI was retrospectively ascertained as an unexplained focal clinical or radiologic decline. Results: 19 patients underwent EEG monitoring (median 10 days, IQR 9-11). Late epileptiform or rhythmic patterns emerged in 14 patients (74%). There was a strong trend towards NPhys-EEG-IS being associated with DCI (univariate OR 8.4, p=0.15), which persisted (multivariate OR 7.5, p=0.08) after adjusting for the association of Hunt-Hess grade >4 and DCI (multivariate OR 3.4, p=0.27). Of 11 patients (58%) with NPhys-EEG-IS alarms, 6 developed DCI (Se 86%, Sp 58%, PPV 55%). DCI was not associated with longer NPhys-EEG-IS alarm duration (5.0 vs. 4.8 alarm-days; NS). The Comp-EEG-IS method was problematic, resulting in multiple false alarms per patient-day; we identified several clinical variables contributing to false alarms. Conclusions: When applied purely quantitatively, published EEG trend analysis methods result in unacceptably high false alarm rates. Neurophysiologist integration of quantitative and raw EEG data modestly improves the predictive value of EEG ischemic signs and affords relatively high sensitivity. Better understanding of specific EEG signatures of confounding variables, and real-time integration of parallel clinical data are required for more accurate EEG DCI detection in clinical practice.

Microwave Heating of Long-term Formalin-fixed Surgical Pathology Specimens Improves Quality of Extracted DNA

A large amount of DNA of high quality is essential for molecular analysis. The amount of DNA in routine paraffin sections is small. Surgical specimens retained in formalin for the long-term (several months) left over from the sampling required for wax embedding can be referred to as "long-term formalin-fixed" specimens, and clearly this material is a rich source of DNA; however, it is difficult to extract. In the current study, we designed a microwave-heating method for DNA extraction from these specimens. We found that the heating procedure achieved greater DNA yields than a common nonheating method used for comparison (DNA contents mean±SD, heating 2.16±0.95 μg/μL vs. common 1.75±0.90 μg/μL, P<0.05). Fluorescence multiplex polymerase chain reaction-capillary electrophoresis successfully detected microsatellite instability (MSI) in the DNA samples derived from this heating procedure (98.4%, 689 of 700 sample tests), at significantly higher levels than from the conventional method (82.3%, 247 of 300 sample tests, P<0.05). We identified 10 (14.3%) MSI with high frequency and 6 (8.6%) MSI with low frequency colorectal cancers. MSI with high frequency cancers showed distinct clinicopathologic features including higher incidence of right-sided location, high histologic grade, mucin-production, and prominent intraepithelial lymphocyte infiltration. We concluded that the microwave-heating method was efficient for DNA isolation from long-term formalin-fixed tissue samples. The successful fluorescence multiplex polymerase chain reaction-capillary electrophoresis analysis in these samples might facilitate MSI detection in clinical practice.

A computerized scheme for lung nodule detection in multiprojection chest radiography

Our previous study indicated that multiprojection chest radiography could significantly improve radiologists' performance for lung nodule detection in clinical practice. In this study, the authors further verify that multiprojection chest radiography can greatly improve the performance of a computer-aided diagnostic (CAD) scheme. Our database consisted of 59 subjects, including 43 subjects with 45 nodules and 16 subjects without nodules. The 45 nodules included 7 real and 38 simulated ones. The authors developed a conventional CAD scheme and a new fusion CAD scheme to detect lung nodules. The conventional CAD scheme consisted of four steps for (1) identification of initial nodule candidates inside lungs, (2) nodule candidate segmentation based on dynamic programming, (3) extraction of 33 features from nodule candidates, and (4) false positive reduction using a piecewise linear classifier. The conventional CAD scheme processed each of the three projection images of a subject independently and discarded the correlation information between the three images. The fusion CAD scheme included the four steps in the conventional CAD scheme and two additional steps for (5) registration of all candidates in the three images of a subject, and (6) integration of correlation information between the registered candidates in the three images. The integration step retained all candidates detected at least twice in the three images of a subject and removed those detected only once in the three images as false positives. A leave-one-subject-out testing method was used for evaluation of the performance levels of the two CAD schemes. At the sensitivities of 70%, 65%, and 60%, our conventional CAD scheme reported 14.7, 11.3, and 8.6 false positives per image, respectively, whereas our fusion CAD scheme reported 3.9, 1.9, and 1.2 false positives per image, and 5.5, 2.8, and 1.7 false positives per patient, respectively. The low performance of the conventional CAD scheme may be attributed to the high noise level in chest radiography, and the small size and low contrast of most nodules. This study indicated that the fusion of correlation information in multiprojection chest radiography can markedly improve the performance of CAD scheme for lung nodule detection.

Accuracy of receptor-based methods for detection of thyrotropin-receptor autoantibodies: a new automated third-generation immunoassay shows higher analytical and clinical sensitivity for the differential diagnosis of hyperthyroidism.

PurposeSpecific autoantibodies acting as TSH receptor agonists (TRAb) are responsible for Graves’ disease (GD). In the last 30 years three generations of assay methods for the detection of TRAb have become available. The aim of this multicentre study was to evaluate the analytical sensitivity, precision and diagnostic accuracy of TRAb measurement using a new automated assay in comparison with a second-generation standard method.MethodsSerum samples from patients with GD (n=82), autoimmune thyroiditis (AIT, n=57) or hyperthyroidism (HT, n=292), from 106 healthy subjects and from 57 patients with infectious diseases were analysed using a third-generation TRAb immunoassay (anti-TSHR, RAD 120; Radim, Italy) based on the human monoclonal TSH receptor antibody M22.ResultsUsing a cut-off value of 1.25 mIU/l, established by ROC curve analysis, 80/82 GD patients (97.5%), 68/292 HT patients (23.2%), and 6/57 AIT patients (10.5%) were TRAb-positive with the M22-based automated assay. The percentages of TRAb positivity were lower in the same patients when the measurements were done with the second-generation method (95.1%, 18.9%, 7.0%, respectively).ConclusionThe M22-based automated immunoassay shows high functional sensitivity (0.4 mIU/l) and high diagnostic specificity, is more sensitive than the standard second-generation method and is less time-consuming and labourintensive, and is therefore the up-to-date technology for TRAb detection in clinical practice.

Quantum dots-based immunofluorescence technology for the quantitative determination of HER2 expression in breast cancer

HER2 detection is important for breast cancer (BC) treatment and prognosis, but the detection methods currently used have some disadvantages. Quantum dots (QDs)-based probes provide a potentially important new method for HER2 detection in clinical practice. This potential is examined in this paper. A QDs HER2 probe kit and QDs image acquisition and analysis software were developed and applied to 94 clinical samples of BC. Compared to conventional immunohistochemistry techniques, this method provided a superior accurate and sensitive method for the detection of HER2 in clinical breast cancer diagnosis.

Delirium detection in clinical practice and research: Critique of current tools and suggestions for future development

Delirium is underrecognized clinically. Many tools have been developed to assist with the diagnosis of delirium, and they vary greatly in purpose, quality, and administration time. It is suggested that future development of delirium assessment instruments be guided by a dichotomization of raters into expert and nonexpert groups. Careful consideration of the needs of the two groups suggests that assessment instruments designed for nonexperts should be entirely objective, whereas those instruments developed for experts should include the full range of constructs associated with the syndrome. This conceptualization is explored in detail, and existing assessment instruments are considered briefly in light of this position.

New Colonoscopic Technology or Back-to-Basic Techniques?

TO THE EDITOR: We thank Dr. Matsushita and colleagues for their interest in our article that showed that in computerized tomography (CT) simulation of optical colonoscopy use of a wide angle (170°) colonoscope increased absolute surface visualization by approximately 5%, and that simulated addition of retrograde viewing auxiliary imaging device (RVAID) led to almost total surface visualization. Matsushita et al. have concerns about the simulation of retrograde view as they feel that pan-colonic retrograde examination is not feasible in routine clinical settings. We agree with these concerns when using standard or even short bending section instruments. In trials attempting additional retroflexed examination, only the proximal colon was examined because of the real risk of impaction in the more angulated, narrower left colon (1). However, the RVAID that we simulated (Third Eye Retroscope, Avantis Medical, CA) is a catheter-mounted videochip that exits the colonoscope via the biopsy channel for a few inches (2). Unlike a retroflexed colonoscope, the catheter is preshaped to retroflex in a very tight radius (approximately half an inch), making impaction unlikely. The first human trials of this device in 12 patients have recently been reported and appear to confirm this, with safe and successful navigation around flexures and in both the left and right colon (2). It remains to be seen whether the addition of RVAIDs to standard colonoscopes translates into increased adenoma detection in clinical practice.

New Colonoscopic Technology or Back-to-Basic Techniques?

TO THE EDITOR: We thank Dr. Matsushita and colleagues for their interest in our article that showed that in computerized tomography (CT) simulation of optical colonoscopy use of a wide angle (170°) colonoscope increased absolute surface visualization by approximately 5%, and that simulated addition of retrograde viewing auxiliary imaging device (RVAID) led to almost total surface visualization. Matsushita et al. have concerns about the simulation of retrograde view as they feel that pan-colonic retrograde examination is not feasible in routine clinical settings. We agree with these concerns when using standard or even short bending section instruments. In trials attempting additional retroflexed examination, only the proximal colon was examined because of the real risk of impaction in the more angulated, narrower left colon (1). However, the RVAID that we simulated (Third Eye Retroscope, Avantis Medical, CA) is a catheter-mounted videochip that exits the colonoscope via the biopsy channel for a few inches (2). Unlike a retroflexed colonoscope, the catheter is preshaped to retroflex in a very tight radius (approximately half an inch), making impaction unlikely. The first human trials of this device in 12 patients have recently been reported and appear to confirm this, with safe and successful navigation around flexures and in both the left and right colon (2). It remains to be seen whether the addition of RVAIDs to standard colonoscopes translates into increased adenoma detection in clinical practice.

Nanotechnology: A new frontier in virus detection in clinical practice

Researchers are expanding the applications of nanotechnology in the field of medicine since mid-2000. These technologies include nanoarrays, protein arrays, nanopore technology, nanoparticles as a contrivance in immunoassays and nanosensors, among others. Nanobiotechnologies are clinically applicable and possess the potential to be useful in laboratory diagnosis of infections in general and viral infections in particular. Nanotechnology is a significant advance in molecular diagnostics. The technology strengthens and expands the DNA and protein microarray methods. In particular, the waveguide technology is an emergent area with many diagnostic applications. Nanosensors are the new contrivance for detection of bioterrorism agents. All these new technologies would have to be evaluated in clinical settings before their full import is appreciated and accepted.

Computer-Assisted Detection in Clinical Practice: Medical Legal Considerations

Preoperative imaging for early-stage cutaneous melanoma is not recommended by current guidelines. Our goal was to investigate our institutional usage and utility.Patients with clinically node-negative cutaneous melanoma undergoing surgery with sentinel lymph node biopsy were identified retrospectively. Any melanoma-related imaging after diagnosis and before surgery was considered a staging study.Five hundred fifteen studies were performed in 409 of 546 (75%) patients. Chest x-rays was performed in 70% and advanced imaging in 14% (computed tomography imaging, magnetic resonance imaging, ultrasound, and positron-emission computed tomography imaging). No metastatic lesions were identified. A Breslow thickness greater than 4 mm (odds ratio = 6.46 vs <1 mm; 95% confidence interval, 2.07 to 20.15) and male sex (odds ratio = 2.62 vs female; 95% confidence interval, 1.26 to 5.46) were associated with an increased likelihood of advanced imaging.Preoperative imaging was performed in the majority of patients with node-negative melanoma, with 14% undergoing advanced studies. No metastatic lesions were identified, confirming the limited utility in this setting.

Detection of Toxigenic Clostridium difficile in Stool Samples by Real-Time Polymerase Chain Reaction for the Diagnosis of C. difficile-Associated Diarrhea

Clostridium difficile-associated diarrhea (CDAD) is the major cause of health care-associated infectious diarrhea. Current laboratory testing lacks a single assay that is sensitive, specific, and rapid. The purpose of this work was to design and validate a sensitive and specific real-time polymerase chain reaction (PCR) diagnostic test for CDAD. This observational validation study of a new real-time PCR assay occurred from July 2004 through April 2006 and involved the testing of 1368 stool samples. As the final validation portion of the investigation, 350 inpatients were prospectively interviewed for clinical findings for 365 episodes of diarrheal illness. Test results and clinical criteria were used to assess the performance of 4 assays. Using clinical criteria requiring at least 3 loose stools in 1 day as part of the reference standard for a positive test result supporting CDAD, the sensitivity, specificity, and positive and negative predictive values were 73.3%, 97.6%, 73.3%, and 97.6%, respectively, for enzyme immunoassay; 93.3%, 97.4%, 75.7%, and 99.4%, respectively, for real-time PCR; 76.7%, 97.1%, 69.7%, and 97.9%, respectively, for cell culture cytotoxin assay; and 100.0%, 95.9%, 68.2%, and 100.0%, respectively, for anaerobic culture (for toxigenic C. difficile strains). The real-time PCR and anaerobic culture assays were significantly more sensitive than the enzyme immunoassay (P<.01 to P<.05). With an assay turnaround time of <4 h, real-time PCR is a more sensitive and equally rapid test, compared with enzyme immunoassay, and is a feasible laboratory option to replace enzyme immunoassay for toxigenic C. difficile detection in clinical practice, as well as for use during the development of new therapeutic agents.

New Modalities for the Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism

In Brief Venous thromboembolic disease is a serious, but treatable disease, the timely diagnosis of which requires a high level of clinical suspicion. Despite advances in medical technology, pulmonary embolism still manages to evade detection in clinical practice. Deep vein thrombosis (DVT) can be reliably diagnosed with compression ultrasound, although repeat testing several days after a negative test rules out clinically significant DVT most accurately. Because the signs and symptoms of pulmonary embolism (PE) are nonspecific, the diagnosis may be missed if other coexisting conditions are present and presumed to be responsible for the clinical findings. Ventilation/perfusion (VQ) scanning remains an appropriate initial test in patients without underlying ventilation abnormalities seen on chest radiographs. Spiral computerized tomography (CT) can be a useful alternative or an adjunctive diagnostic tool for patients with suspected PE and equivocal VQ scans. Patients with poor cardiopulmonary reserve may need a more aggressive diagnostic approach, given the tendency of spiral CT to miss subsegmental emboli, which may be of great consequence to this group of patients. Pulmonary angiography should be used to confirm the diagnosis in patients with equivocal noninvasive tests and a high pretest probability. A negative d-dimer in the setting of a low pretest probability carries a high negative predictive value. Clinical algorithms based on pretest probability and d-dimer testing are promising methods to decrease the need for imaging in the outpatient setting. Although most cases of pulmonary embolism and deep vein thrombosis respond well to treatment, the timely diagnosis of these disorders remains a major impediment. This article describes the clinically available technology for diagnosis of thromboembolism, and reviews the evidence supporting a rational approach to their use.

Measurement of insulin-like growth factor axis does not enhance specificity of PSA-based prostate cancer screening

Objectives To examine whether measurement of insulin-like growth factor (IGF)-I, IGF-II, IGF binding protein (IGFBP)-2 or IGFBP-3, alone or in combination, enhanced the specificity of prostate cancer detection among men with a prostate-specific antigen (PSA) level of 3 ng/mL or greater beyond that achieved by the free/total PSA index. Methods Cross-sectional analysis was performed on blood samples taken from 597 asymptomatic men (79% of those biopsied) participating in a community case-finding exercise. All men had a total PSA level of 3 ng/mL or greater and had undergone prostate biopsy. Assays of IGF-I, IGF-II, IGFBP-2, IGFBP-3, and free and total PSA were performed. The predictive performance of a range of measures was assessed using receiver operating characteristic analyses and compared with the free/total PSA index, for all biopsies and for men with a PSA level of 3 to 10 ng/mL. The overall test performance was summarized using the area under the receiver operating characteristic curve (AUC). Results Of the 597 men, 185 (31.0%) had prostate cancer identified at biopsy. When all biopsies were included, the performance of the free/total PSA index (AUC 0.73) was significantly greater than for IGF-I (AUC 0.59; P <0.0001), IGF-I/PSA ratio (AUC 0.65; P = 0.002), IGF-I + IGFBP-3 (AUC 0.59; P <0.0001), IGF-II (AUC 0.66; P = 0.002), and IGF-II + IGFBP-3 (AUC 0.67; P = 0.05). The combined measurement of free/total PSA, IGF-II, and IGFBP-3 resulted in a slight improvement in performance (AUC 0.76; P = 0.01). The results were similar when the analyses were restricted to men with an initial PSA level of 3 to 10 ng/mL. Conclusions We found no evidence that measurement of the IGF axis enhances the specificity of prostate cancer detection in clinical practice beyond that achievable using the free/total PSA index.

Genetic variation and lactose intolerance: detection methods and clinical implications.

The maturational decline in lactase activity renders most of the world's adult human population intolerant of excessive consumption of milk and other dairy products. In conditions of primary or secondary lactase deficiency, the lactose sugars in milk pass through the gastrointestinal tract undigested or are partially digested by enzymes produced by intestinal bacterial flora to yield short chain fatty acids, hydrogen, carbon dioxide, and methane. The undigested lactose molecules and products of bacterial digestion can result in symptoms of lactose intolerance, diarrhea, gas bloat, flatulence, and abdominal pain. Diagnosis of lactose intolerance is often made on clinical grounds and response to an empiric trail of dietary lactose avoidance. Biochemical methods for assessing lactose malabsorption in the form of the lactose breath hydrogen test and direct lactase enzyme activity performed on small intestinal tissue biopsy samples may also be utilized. In some adults, however, high levels of lactase activity persist into adulthood. This hereditary persistence of lactase is common primarily in people of northern European descent and is attributed to inheritance of an autosomal-dominant mutation that prevents the maturational decline in lactase expression. Recent reports have identified genetic polymorphisms that are closely associated with lactase persistence and nonpersistence phenotypes. The identification of genetic variants associated with lactase persistence or nonpersistence allows for molecular detection of the genetic predisposition towards adult-onset hypolactasia by DNA sequencing or restriction fragment length polymorphism analysis. The role for such genetic detection in clinical practice seems limited to ruling out adult-onset hypolactasia as a cause of intolerance symptoms but remains to be fully defined. Attention should be paid to appropriate interpretation of genetic detection in order to avoid potentially harmful reduction in dairy intake or misdiagnosis of secondary lactase deficiency.

Improved detection of lupus anticoagulants by the dilute Russell's Viper venom time.

Accurate and timely detection of lupus anticoagulants (LAs) is of diagnostic and prognostic importance due to the association of persistent LAs with thrombotic disease. A review of LA screening results by kaolin clotting time and dilute Russell's Viper venom time (dRVVT) on 2843 patient samples demonstrated that only 40.7% (417 of 1024) of elevated dRVVT ratios could be interpreted as consistent with the presence of an LA by confirmatory procedures. Apart from those due to the effects of anticoagulant therapy, the remainder generated inconclusive interpretations, necessitating significant numbers of costly repeat investigations. Manipulation of dRVVT assay conditions by increasing confirmatory reagent concentration, and altering venom concentration to maintain analytical parity with the standard assay, revealed LAs not fully neutralized by confirmatory tests at standard concentrations. Further experiments were performed using Russell's Viper venom reagents from five different manufacturers to demonstrate that the findings were not a reagent-specific phenomenon. Higher detection rates were achieved using multiple conventional assays but samples remained that required a modified confirmatory test to demonstrate LA activity. A previously unreported group of LAs was identified with raised dRVVT ratios that failed to correct with any of the dRVVT assays but demonstrated significant correction with all reagents in the modified confirmatory test. Use of modified confirmatory tests enhances sensitivity and specificity, and doubles LA detection rates by dRVVT. Adoption of the technique will significantly increase cost-effectiveness of LA detection in clinical practice.

Achieving plasma HIV RNA below the level of detection in clinical practice

Clinical trials have shown that highly active antiretroviral therapy (HAART) reduces plasma HIV RNA below the detection level in up to 90 per cent of patients. To assess the independent predictors that are associated with achieving undetectable plasma HIV RNA in the daily clinical practice, we carried out a retrospective study. Among 106 HIV-infected patients treated with HAART, 63 (59 per cent) achieved undetectable plasma HIV RNA (less than 400 copies/ml) at their last visit. Adherence with HAART (greater than 80 per cent of prescribed dose) was self-reported by 81 patients (76 per cent). Independent predictors of achieving undetectable plasma HIV RNA were: self-reported adherence to therapy (Odds ratio [OR] 11.79, 95 per cent Confidence intervals [CI]: 3.55-33.17, p = 0.0001) and lack of previous antiretroviral therapy (OR: 3.12, 95 per cent CI: 1.09-8.96, p = 0.03). The efficacy of antiretroviral therapy observed in the daily clinical practice was noticeably lower than that reported in clinical trials. Patient adherence with prescribed HAART and lack of previous antiretroviral therapy are important factors related to successful therapy in the real world.

Erratum

This article has been withdrawn as it was published elsewhere and accidentally duplicated. The original article can be seen here: 10.1108/14664100010343971. When citing the article, please cite: Javier Ena, Concepción Benito, (2000), “Achieving plasma HIV RNA below the level of detection in clinical practice”, British Journal of Clinical Governance, Vol. 5 Iss 2 pp. 100 - 105.