论文标题
最佳分配金标准测试在有限的可用性下：应用于评估HIV治疗失败
Optimal Allocation of Gold Standard Testing under Constrained Availability: Application to Assessment of HIV Treatment Failure
论文作者
论文摘要
世界卫生组织（WHO）监测在资源有限环境（RLS）中监测HIV治疗有效性的指南主要基于临床和免疫标记（例如CD4细胞计数）。最近的研究表明，该指南不足，可能导致高错误率。病毒载荷（VL）被认为是“黄金标准”，但其广泛使用受成本和基础设施的限制。在本文中，我们提出了一种诊断算法，该算法使用常规收集的临床和免疫学标记物中的信息来指导选择性使用VL测试来诊断HIV治疗失败，这是在仅在患者就诊的一定部分中可用的VL测试的。我们的算法确定了患者的亚群，以便在其上使用有限的VL测试可最大程度地减少预定义的风险（例如，误诊错误率）。通过模拟评估我们的提案算法的诊断特性。为了说明，分析了Miriam医院免疫学诊所（RI，美国）的数据。
The World Health Organization (WHO) guidelines for monitoring the effectiveness of HIV treatment in resource-limited settings (RLS) are mostly based on clinical and immunological markers (e.g., CD4 cell counts). Recent research indicates that the guidelines are inadequate and can result in high error rates. Viral load (VL) is considered the "gold standard", yet its widespread use is limited by cost and infrastructure. In this paper, we propose a diagnostic algorithm that uses information from routinely-collected clinical and immunological markers to guide a selective use of VL testing for diagnosing HIV treatment failure, under the assumption that VL testing is available only at a certain portion of patient visits. Our algorithm identifies the patient subpopulation, such that the use of limited VL testing on them minimizes a pre-defined risk (e.g., misdiagnosis error rate). Diagnostic properties of our proposal algorithm are assessed by simulations. For illustration, data from the Miriam Hospital Immunology Clinic (RI, USA) are analyzed.
