An audit of viral load in one clinical population to describe features of viraemic patients on antiretroviral therapy.
OBJECTIVE
To assess the prevalence of an undetectable viral load (VL) (<50 HIV-1 RNA copies/mL) in a clinical population and to identify those viraemic and at risk of failing antiretroviral therapy (ART).


METHODS
An audit of a complete clinical population on 1 January 2005 via a clinical database and clinical note review.


RESULTS
On 1 January 2005, 1910 patients were under care; 1229/1332 (92%) of those exposed to ART for >16 weeks had a VL of <50 copies/mL. We examined 49/56 case notes of viraemic patients to identify explanations for viraemia. Common reasons included previous initial mono- or dual therapy, adherence problems, more advanced HIV disease, concomitant medications, physical and mental health issues and being less well linked into the service. A review of these patients' current status on 1 April 2007 showed that six of the 49 had since died. However, of those still alive, 20 (47%) had a VL <500 copies/mL.


CONCLUSIONS
The proportion of patients on ART with detectable viraemia is low in current clinical practice. New drugs may help those who are failing because of resistance. However, there is a small minority of patients who, for various reasons, appear unable to maintain sufficient adherence to ART.
Madge
S
S
Royal Free Centre for HIV Medicine, Royal Free and University College London Medical School, London, UK. s.madge@pcps.ucl.ac.uk
Smith
C J
CJ
Lampe
F
F
Sabin
C A
CA
Youle
M
M
Johnson
M A
MA
Phillips
A N
AN
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral; D012189:Retrospective Studies; D017211:Treatment Failure; D019562:Viral Load; D014766:Viremia / Q000188:drug therapy*
D019380:Anti-HIV Agents; D012367:RNA, Viral