Single Viral Load Measurements Overestimate Stable Viral Suppression Among HIV Patients in Care: Clinical and Public Health Implications.
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.



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.



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.



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.
*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 Affairs Medical Center, Houston, TX; #Department of Medicine, Boston University School of Medicine, Boston, MA; **Carter Consulting, Inc, Atlanta, GA; ††Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL; ‡‡Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL; §§Center for AIDS and STD and Public Health-Seattle and King County, University of Washington, Seattle, WA; ‖‖Department of Medicine, University of Washington, Seattle, WA; ¶¶School of Public Health, Boston University, Boston, MA; and ##Mailman School of Public Health, Columbia University, New York, NY.
Gary
G
Marks
Unnati
U
Patel
Michael J
MJ
Stirratt
Michael J
MJ
Mugavero
William C
WC
Mathews
Thomas P
TP
Giordano
Nicole
N
Crepaz
Lytt I
LI
Gardner
Cynthia
C
Grossman
Jessica
J
Davila
Meg
M
Sullivan
Charles E
CE
Rose
Christine
C
OʼDaniels
Allan
A
Rodriguez
Andrew J
AJ
Wawrzyniak
Matthew R
MR
Golden
Shireesha
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Dhanireddy
Jacqueline
J
Ellison
Mari-Lynn
ML
Drainoni
Lisa R
LR
Metsch
Edward R
ER
Cachay
D015658:HIV Infections / Q000821:virology*; D006801:Humans; D015980:Public Health Practice; D019562:Viral Load