Progress Realized: Trends in HIV-1 Viral Load and CD4 Cell Count in a Tertiary-Care Center from 1999 through 2011

Gale, Howard B.; Rodríguez, Manuel de Buenaga; Hoffman, Heather J.; Benator, Debra; Gordin, Fred M.; Labriola, Ann M.; Kan, Virginia L.

doi:10.1371/journal.pone.0056845

Cited by 8 publications

(8 citation statements)

References 34 publications

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“…Our prior examinations of CD4 cell count and viral loads from 1999 to 2011 demonstrated considerable improvement in median CD4 cell count and the percentage of patients with virologic suppression [ 2 ] as also demonstrated elsewhere [ 3 ]. Now, in the era of potent antiretroviral therapy and capacity for genotypic resistance testing to guide therapy, the occurrence of viral rebound may reflect our challenges with retention in care and adherence to antiretrovirals [ 4 ].…”

Section: Discussionsupporting

confidence: 65%

True Durability: HIV Virologic Suppression in an Urban Clinic and Implications for Timing of Intensive Adherence Efforts and Viral Load Monitoring

et al. 2014

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Although the majority of HIV-infected patients who begin potent antiretroviral therapy should expect long-term virologic suppression, the realities in practice are less certain. Durability of viral suppression was examined to define the best timing of targeted adherence strategies and intensive viral load monitoring in an urban clinic population with multiple challenges to ART adherence. We examined the risk of viral rebound for patients who achieved two consecutive viral loads lower than the lower limit of quantification (LLOQ) within 390 days. For 791 patients with two viral loads below the LLOQ, viral rebound >LLOQ from the first viral load was 36.9 % (95 % CI 32.2–41.6) in the first year, 26.9 % (95 % CI 21.7–32.1) in the year following one year of viral suppression, and 24.6 % (95 % CI 18.4–30.9) in the year following 2 years of viral suppression. However, for patients with CD4 ≥300 cells/µl who had 3–6 years of virologic suppression, the risk of viral rebound was very low. At the population level, the risk of viral rebound in a complex urban clinic population is surprisingly high even out to 3 years. Intensified monitoring and adherence efforts should target this high risk period. Thereafter, confidence in truly durable virologic suppression is improved.

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Section: Discussionsupporting

confidence: 65%

True Durability: HIV Virologic Suppression in an Urban Clinic and Implications for Timing of Intensive Adherence Efforts and Viral Load Monitoring

et al. 2014

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“…HIV RNA viral load (VL) is a pivotal outcome variable in studies of HIV infected persons. Viral load measures are central to clinical trials of new antiretroviral (ART) therapy regimens [ 1 , 2 ], randomized trials of ART adherence [ 3 ], and observational cohort studies of HIV patients [ 4 – 12 ]. In addition, VL is a key component of surveillance databases that provide information on the continuum of care of HIV patients [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Methods for Analyzing Viral Load Data in Studies of HIV Patients

et al. 2015

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HIV RNA viral load (VL) is a pivotal outcome variable in studies of HIV infected persons. We propose and investigate two frameworks for analyzing VL: (1) a single-measure VL (SMVL) per participant and (2) repeated measures of VL (RMVL) per participant. We compared these frameworks using a cohort of 720 HIV patients in care (4,679 post-enrollment VL measurements). The SMVL framework analyzes a single VL per participant, generally captured within a “window” of time. We analyzed three SMVL methods where the VL binary outcome is defined as suppressed or not suppressed. The omit-participant method uses a 8-month “window” (-6/+2 months) around month 24 to select the participant’s VL closest to month 24 and removes participants from the analysis without a VL in the “window”. The set-to-failure method expands on the omit-participant method by including participants without a VL within the “window” and analyzes them as not suppressed. The closest-VL method analyzes each participant’s VL measurement closest to month 24. We investigated two RMVL methods: (1) repeat-binary classifies each VL measurement as suppressed or not suppressed and estimates the proportion of participants suppressed at month 24, and (2) repeat-continuous analyzes VL as a continuous variable to estimate the change in VL across time, and geometric mean (GM) VL and proportion of participants virally suppressed at month 24. Results indicated the RMVL methods have more precision than the SMVL methods, as evidenced by narrower confidence intervals for estimates of proportion suppressed and risk ratios (RR) comparing demographic strata. The repeat-continuous method had the most precision and provides more information than other considered methods. We generally recommend using the RMVL framework when there are repeated VL measurements per participant because it utilizes all available VL data, provides additional information, has more statistical power, and avoids the subjectivity of defining a “window.”

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“…Reports from individual clinics suggest high levels of viral suppression (5), but current large-scale estimates from across the United States are limited. One of the best assessments was from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), which found peak viral suppression of 72%; however, key potential predictors, such as adherence and substance use, were not examined (6).…”

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confidence: 99%

HIV Viral Suppression Trends Over Time Among HIV-Infected Patients Receiving Care in the United States, 1997 to 2015

et al. 2018

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Progress Realized: Trends in HIV-1 Viral Load and CD4 Cell Count in a Tertiary-Care Center from 1999 through 2011

Cited by 8 publications

References 34 publications

True Durability: HIV Virologic Suppression in an Urban Clinic and Implications for Timing of Intensive Adherence Efforts and Viral Load Monitoring

True Durability: HIV Virologic Suppression in an Urban Clinic and Implications for Timing of Intensive Adherence Efforts and Viral Load Monitoring

A Comparison of Methods for Analyzing Viral Load Data in Studies of HIV Patients

HIV Viral Suppression Trends Over Time Among HIV-Infected Patients Receiving Care in the United States, 1997 to 2015

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