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Single Viral Load Measurements Overestimate Stable Viral Suppression Among HIV Patients in Care: Clinical and Public Health Implications.
Marks, Gary; Patel, Unnati; Stirratt, Michael J; Mugavero, Michael J; Mathews, William C; Giordano, Thomas P; Crepaz, Nicole; Gardner, Lytt I; Grossman, Cynthia; Davila, Jessica; Sullivan, Meg; Rose, Charles E; OʼDaniels, Christine; Rodriguez, Allan; Wawrzyniak, Andrew J; Golden, Matthew R; Dhanireddy, Shireesha; Ellison, Jacqueline; Drainoni, Mari-Lynn; Metsch, Lisa R; Cachay, Edward R.
Afiliación
  • Marks G; *Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA; †ICF International, Atlanta, GA; ‡Division of AIDS Research, National Institute of Mental Health, Bethesda, MD; §1917 HIV/AIDS Clinic and Department of Medicine, University of Alabama, Birmingham; ‖Department of Medicine, University of California, San Diego; ¶Department of Medicine, Baylor College of Medicine, and the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans
J Acquir Immune Defic Syndr ; 73(2): 205-12, 2016 10 01.
Article en En | MEDLINE | ID: mdl-27105049
ABSTRACT

BACKGROUND:

The HIV continuum of care paradigm uses a single viral load test per patient to estimate the prevalence of viral suppression. We compared this single-value approach with approaches that used multiple viral load tests to examine the stability of suppression.

METHODS:

The retrospective analysis included HIV patients who had at least 2 viral load tests during a 12-month observation period. We assessed the (1) percent with suppressed viral load (<200 copies/mL) based on a single test during observation, (2) percent with suppressed viral loads on all tests during observation, (3) percent who maintained viral suppression among patients whose first observed viral load was suppressed, and (4) change in viral suppression status comparing first with last measurement occasions. Prevalence ratios compared demographic and clinical subgroups.

RESULTS:

Of 10,942 patients, 78.5% had a suppressed viral load based on a single test, whereas 65.9% were virally suppressed on all tests during observation. Of patients whose first observed viral load was suppressed, 87.5% were suppressed on all subsequent tests in the next 12 months. More patients exhibited improving status (13.3% went from unsuppressed to suppressed) than worsening status (5.6% went from suppressed to unsuppressed). Stable suppression was less likely among women, younger patients, black patients, those recently diagnosed with HIV, and those who missed ≥1 scheduled clinic visits.

CONCLUSIONS:

Using single viral load measurements overestimated the percent of HIV patients with stable suppressed viral load by 16% (relative difference). Targeted clinical interventions are needed to increase the percent of patients with stable suppression.
Asunto(s)

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Infecciones por VIH / Práctica de Salud Pública / Carga Viral Tipo de estudio: Risk_factors_studies Idioma: En Revista: J Acquir Immune Defic Syndr Asunto de la revista: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Año: 2016 Tipo del documento: Article

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Infecciones por VIH / Práctica de Salud Pública / Carga Viral Tipo de estudio: Risk_factors_studies Idioma: En Revista: J Acquir Immune Defic Syndr Asunto de la revista: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Año: 2016 Tipo del documento: Article