Single Viral Load Measurements Overestimate Stable Viral Suppression Among HIV Patients in Care: Clinical and Public Health Implications
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 analy...
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| Veröffentlicht in: | Journal of acquired immune deficiency syndromes (1999) 2016-10, Vol.73 (2), p.205-212 |
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| creator | 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 |
| description | 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 ( |
| doi_str_mv | 10.1097/QAI.0000000000001036 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5964607</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1827894819</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5186-aebd89fb14e3a1107b851fb0bed8905381f27efbfc357599c89645eef907669d3</originalsourceid><addsrcrecordid>eNqNks9u1DAQxiMEoqXwBghZ4sJli53Yic0BabUCdqVFLVro1XKSya6LYwc7acUb8NhMu2VVekD44j_z-z7NjCfLXjJ6yqiq3n6Zr07pvcVoUT7KjpnifFZJyR_jWeRixlkhjrJnKV0iU3KunmZHecWooFwdZ7821m8dkAsbjSPrYFryGUyaIvTgx0TOriBCGm1vRiCb0dQHdjMNA4aSDZ7M--C3ZLm6IOdmtLdC68nCRHhHFs5626DA-JacT7WzDVmCceOOrPoBb6gIPj3PnnTGJXhxt59k3z5--LpYztZnn1aL-XrWCCbLmYG6laqrGYfCMEarWgrW1bQGfKaikKzLK-jqrilEJZRqpCq5AOgUrcpStcVJ9n7vO0x1D22DyWI1eohYYvypg7H674i3O70NV1qgUUkrNHhzZxDDjwl7o3ubGnDOeAhT0kzmlVRcMvU_KBUqV1Qi-voBehmm6LETN5RATlKKFN9TTQwpRegOeTOqb6ZC41Toh1OBslf3az6I_owBAnIPXAc3Qkzf3XQNUe9uv-nf3r8B6e7Esg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1825205800</pqid></control><display><type>article</type><title>Single Viral Load Measurements Overestimate Stable Viral Suppression Among HIV Patients in Care: Clinical and Public Health Implications</title><source>MEDLINE</source><source>Journals@Ovid LWW Legacy Archive</source><source>Journals@Ovid Complete</source><source>Free E- Journals</source><creator>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</creator><creatorcontrib>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</creatorcontrib><description>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.</description><identifier>ISSN: 1525-4135</identifier><identifier>EISSN: 1944-7884</identifier><identifier>DOI: 10.1097/QAI.0000000000001036</identifier><identifier>PMID: 27105049</identifier><identifier>CODEN: JDSRET</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>AIDS/HIV ; Demographics ; HIV ; HIV Infections - virology ; Human immunodeficiency virus ; Humans ; Intervention ; Lentivirus ; Public health ; Public Health Practice ; Retroviridae ; Viral Load</subject><ispartof>Journal of acquired immune deficiency syndromes (1999), 2016-10, Vol.73 (2), p.205-212</ispartof><rights>Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.</rights><rights>Copyright Lippincott Williams & Wilkins Oct 1, 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5186-aebd89fb14e3a1107b851fb0bed8905381f27efbfc357599c89645eef907669d3</citedby><cites>FETCH-LOGICAL-c5186-aebd89fb14e3a1107b851fb0bed8905381f27efbfc357599c89645eef907669d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,777,781,882,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27105049$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Marks, Gary</creatorcontrib><creatorcontrib>Patel, Unnati</creatorcontrib><creatorcontrib>Stirratt, Michael J</creatorcontrib><creatorcontrib>Mugavero, Michael J</creatorcontrib><creatorcontrib>Mathews, William C</creatorcontrib><creatorcontrib>Giordano, Thomas P</creatorcontrib><creatorcontrib>Crepaz, Nicole</creatorcontrib><creatorcontrib>Gardner, Lytt I</creatorcontrib><creatorcontrib>Grossman, Cynthia</creatorcontrib><creatorcontrib>Davila, Jessica</creatorcontrib><creatorcontrib>Sullivan, Meg</creatorcontrib><creatorcontrib>Rose, Charles E</creatorcontrib><creatorcontrib>OʼDaniels, Christine</creatorcontrib><creatorcontrib>Rodriguez, Allan</creatorcontrib><creatorcontrib>Wawrzyniak, Andrew J</creatorcontrib><creatorcontrib>Golden, Matthew R</creatorcontrib><creatorcontrib>Dhanireddy, Shireesha</creatorcontrib><creatorcontrib>Ellison, Jacqueline</creatorcontrib><creatorcontrib>Drainoni, Mari-Lynn</creatorcontrib><creatorcontrib>Metsch, Lisa R</creatorcontrib><creatorcontrib>Cachay, Edward R</creatorcontrib><title>Single Viral Load Measurements Overestimate Stable Viral Suppression Among HIV Patients in Care: Clinical and Public Health Implications</title><title>Journal of acquired immune deficiency syndromes (1999)</title><addtitle>J Acquir Immune Defic Syndr</addtitle><description>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.</description><subject>AIDS/HIV</subject><subject>Demographics</subject><subject>HIV</subject><subject>HIV Infections - virology</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Intervention</subject><subject>Lentivirus</subject><subject>Public health</subject><subject>Public Health Practice</subject><subject>Retroviridae</subject><subject>Viral Load</subject><issn>1525-4135</issn><issn>1944-7884</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNks9u1DAQxiMEoqXwBghZ4sJli53Yic0BabUCdqVFLVro1XKSya6LYwc7acUb8NhMu2VVekD44j_z-z7NjCfLXjJ6yqiq3n6Zr07pvcVoUT7KjpnifFZJyR_jWeRixlkhjrJnKV0iU3KunmZHecWooFwdZ7821m8dkAsbjSPrYFryGUyaIvTgx0TOriBCGm1vRiCb0dQHdjMNA4aSDZ7M--C3ZLm6IOdmtLdC68nCRHhHFs5626DA-JacT7WzDVmCceOOrPoBb6gIPj3PnnTGJXhxt59k3z5--LpYztZnn1aL-XrWCCbLmYG6laqrGYfCMEarWgrW1bQGfKaikKzLK-jqrilEJZRqpCq5AOgUrcpStcVJ9n7vO0x1D22DyWI1eohYYvypg7H674i3O70NV1qgUUkrNHhzZxDDjwl7o3ubGnDOeAhT0kzmlVRcMvU_KBUqV1Qi-voBehmm6LETN5RATlKKFN9TTQwpRegOeTOqb6ZC41Toh1OBslf3az6I_owBAnIPXAc3Qkzf3XQNUe9uv-nf3r8B6e7Esg</recordid><startdate>20161001</startdate><enddate>20161001</enddate><creator>Marks, Gary</creator><creator>Patel, Unnati</creator><creator>Stirratt, Michael J</creator><creator>Mugavero, Michael J</creator><creator>Mathews, William C</creator><creator>Giordano, Thomas P</creator><creator>Crepaz, Nicole</creator><creator>Gardner, Lytt I</creator><creator>Grossman, Cynthia</creator><creator>Davila, Jessica</creator><creator>Sullivan, Meg</creator><creator>Rose, Charles E</creator><creator>OʼDaniels, Christine</creator><creator>Rodriguez, Allan</creator><creator>Wawrzyniak, Andrew J</creator><creator>Golden, Matthew R</creator><creator>Dhanireddy, Shireesha</creator><creator>Ellison, Jacqueline</creator><creator>Drainoni, Mari-Lynn</creator><creator>Metsch, Lisa R</creator><creator>Cachay, Edward R</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T2</scope><scope>7T5</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>7U2</scope><scope>5PM</scope></search><sort><creationdate>20161001</creationdate><title>Single Viral Load Measurements Overestimate Stable Viral Suppression Among HIV Patients in Care: Clinical and Public Health Implications</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5186-aebd89fb14e3a1107b851fb0bed8905381f27efbfc357599c89645eef907669d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>AIDS/HIV</topic><topic>Demographics</topic><topic>HIV</topic><topic>HIV Infections - virology</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Intervention</topic><topic>Lentivirus</topic><topic>Public health</topic><topic>Public Health Practice</topic><topic>Retroviridae</topic><topic>Viral Load</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Marks, Gary</creatorcontrib><creatorcontrib>Patel, Unnati</creatorcontrib><creatorcontrib>Stirratt, Michael J</creatorcontrib><creatorcontrib>Mugavero, Michael J</creatorcontrib><creatorcontrib>Mathews, William C</creatorcontrib><creatorcontrib>Giordano, Thomas P</creatorcontrib><creatorcontrib>Crepaz, Nicole</creatorcontrib><creatorcontrib>Gardner, Lytt I</creatorcontrib><creatorcontrib>Grossman, Cynthia</creatorcontrib><creatorcontrib>Davila, Jessica</creatorcontrib><creatorcontrib>Sullivan, Meg</creatorcontrib><creatorcontrib>Rose, Charles E</creatorcontrib><creatorcontrib>OʼDaniels, Christine</creatorcontrib><creatorcontrib>Rodriguez, Allan</creatorcontrib><creatorcontrib>Wawrzyniak, Andrew J</creatorcontrib><creatorcontrib>Golden, Matthew R</creatorcontrib><creatorcontrib>Dhanireddy, Shireesha</creatorcontrib><creatorcontrib>Ellison, Jacqueline</creatorcontrib><creatorcontrib>Drainoni, Mari-Lynn</creatorcontrib><creatorcontrib>Metsch, Lisa R</creatorcontrib><creatorcontrib>Cachay, Edward R</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>Safety Science and Risk</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of acquired immune deficiency syndromes (1999)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Marks, Gary</au><au>Patel, Unnati</au><au>Stirratt, Michael J</au><au>Mugavero, Michael J</au><au>Mathews, William C</au><au>Giordano, Thomas P</au><au>Crepaz, Nicole</au><au>Gardner, Lytt I</au><au>Grossman, Cynthia</au><au>Davila, Jessica</au><au>Sullivan, Meg</au><au>Rose, Charles E</au><au>OʼDaniels, Christine</au><au>Rodriguez, Allan</au><au>Wawrzyniak, Andrew J</au><au>Golden, Matthew R</au><au>Dhanireddy, Shireesha</au><au>Ellison, Jacqueline</au><au>Drainoni, Mari-Lynn</au><au>Metsch, Lisa R</au><au>Cachay, Edward R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Single Viral Load Measurements Overestimate Stable Viral Suppression Among HIV Patients in Care: Clinical and Public Health Implications</atitle><jtitle>Journal of acquired immune deficiency syndromes (1999)</jtitle><addtitle>J Acquir Immune Defic Syndr</addtitle><date>2016-10-01</date><risdate>2016</risdate><volume>73</volume><issue>2</issue><spage>205</spage><epage>212</epage><pages>205-212</pages><issn>1525-4135</issn><eissn>1944-7884</eissn><coden>JDSRET</coden><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.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>27105049</pmid><doi>10.1097/QAI.0000000000001036</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | AIDS/HIV Demographics HIV HIV Infections - virology Human immunodeficiency virus Humans Intervention Lentivirus Public health Public Health Practice Retroviridae Viral Load |
| title | Single Viral Load Measurements Overestimate Stable Viral Suppression Among HIV Patients in Care: Clinical and Public Health Implications |
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