title: Factors associated with HIV RNA viral loads in ART-naïve patients: implications for treatment as prevention in concentrated epidemics.
abstract: BACKGROUND
  Limited data are available on factors associated with HIV-RNA viral load (VL) among antiretroviral treatment (ART)-naïve key populations in concentrated epidemics.
  
  
  METHODS
  We conducted a cross-sectional survey of 1211 adult ART-naïve patients at 19 HIV clinics in Ho Chi Minh City (HCMC), Vietnam. Data collection included a standardised questionnaire, routine laboratory testing, hepatitis serology and HIV VL. Correlation between CD4 cell count and VL was assessed across all participants. In 904 participants not meeting Vietnam criteria for ART (CD4 cell count >350 cells/mm(3), WHO clinical stage 1 or 2 and not pregnant), multivariate analyses were conducted to assess factors associated with HIV VL.
  
  
  RESULTS
  Pre-ART patients had a median age of 31 years and 54% were male. Median CD4 cell count was 533 cells/mm(3). Median HIV VL was 17,378 copies/mL; 60% had VL greater than 10,000 copies/mL and 16% had VL above 100,000 copies/mL. Although declining CD4 cell count was correlated with rising VL across all CD4 cell counts, correlation of VL with CD4 cell counts between 351 and 500 cell/mm(3) was not significant. On multivariate linear regression, higher HIV VL was independently associated with male sex, men who have sex with men (MSM), CD4 cell count 351-500, HIV diagnosis within the previous 6 months, and hepatitis B (HBV). Lower HIV VL was independently associated with hepatitis C (HCV).
  
  
  CONCLUSIONS
  The majority of HIV patients who were not eligible for ART in HCMC in 2014 had HIV VL greater than 10,000 copies/mL. These data support expanded eligibility of ART to all HIV patients with the goal of treatment as prevention. This study is also among the first to demonstrate that MSM had a higher VL than women and heterosexual men and highlights the need for improved outreach and linkages to HIV care for this high-risk group.
authors.affiliation: FHI 360 , Ho Chi Minh City , Vietnam.
authors.forename: Suresh
authors.initials: S
authors.lastname: Rangarajan
authors.affiliation: Center for Applied Research on Men and Health, Ho Chi Minh City, Vietnam; SEARCH, Thai Red Cross AIDS Research Center, Bangkok, Thailand.
authors.forename: Donn J
authors.initials: DJ
authors.lastname: Colby
authors.affiliation: Ho Chi Minh City Provincial AIDS Committee , Ho Chi Minh City , Vietnam.
authors.forename: Giang Le
authors.initials: GL
authors.lastname: Truong
authors.affiliation: Ho Chi Minh City Provincial AIDS Committee , Ho Chi Minh City , Vietnam.
authors.forename: Hung Nguyen
authors.initials: HN
authors.lastname: Huu
authors.affiliation: Ho Chi Minh City Provincial AIDS Committee , Ho Chi Minh City , Vietnam.
authors.forename: Van Tieu Thi
authors.initials: VT
authors.lastname: Thu
authors.affiliation: Ho Chi Minh City Provincial AIDS Committee , Ho Chi Minh City , Vietnam.
authors.forename: Binh Luong
authors.initials: BL
authors.lastname: Quoc
authors.affiliation: FHI 360 , Ho Chi Minh City , Vietnam.
authors.forename: Tou Plui
authors.initials: TP
authors.lastname: Broh
authors.affiliation: FHI 360 , Ho Chi Minh City , Vietnam.
authors.forename: Danh Tran
authors.initials: DT
authors.lastname: Tri
authors.affiliation: FHI 360 , Hanoi , Vietnam.
authors.forename: Dao Duc
authors.initials: DD
authors.lastname: Giang
authors.affiliation: FHI 360 North Carolina , USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Chen
authors.affiliation: FHI 360 North Carolina , USA.
authors.forename: Yanwu
authors.initials: Y
authors.lastname: Zeng
authors.affiliation: FHI 360 (retired).
authors.forename: Gary
authors.initials: G
authors.lastname: West
keywords: ART naïve; HIV; HIV viral load; Vietnam; treatment as prevention