Time above 1500 copies: a viral load measure for assessing transmission risk of HIV-positive patients in care

Academic Article

Abstract

  • OBJECTIVE: We examined HIV transmission potential of patients in care by analyzing the amount of person-time spent above a viral load threshold that increases risk for transmission.DESIGN: Observational cohort and supplemental data.METHODS: The cohort included HIV patients who received care at six HIV clinics in the United States, from 1 April 2009 to 31 March 2013, and had two or more viral load tests during this interval. Person-time (in days) above a viral load of 1500 copies/ml out of the total observation time was determined by inspecting consecutive pairs of viral load results and the time intervals between those pairs. The person-time rate ratios comparing demographic and clinical subgroups were estimated with Poisson regression.RESULTS: The cohort included 14 532 patients observed for a median of 1073 days with a median of nine viral load records. Ninety percent of the patients had been prescribed antiretroviral therapy. On average, viral load exceeded 1500 copies/ml during 23% of the patients' observation time (average of 84 days per year, per patient). Percentage of person-time above the threshold was higher among patients who had more than a fourth of their viral load pairs exceeding a 6-month interval (34% of observation time), patients not on antiretroviral therapy (58% of time), new/re-engaging patients (34% of time), patients 16-39 years of age (32% of time), and patients of black race (26% of time).CONCLUSION: HIV patients in care spent an average of nearly a quarter of their time with viral loads above 1500 copies/ml, higher among some subgroups, placing them at risk for potentially transmitting HIV to others.
  • Authors

    Published In

  • AIDS  Journal
  • Digital Object Identifier (doi)

    Author List

  • Marks G; Gardner LI; Rose CE; Zinski A; Moore RD; Holman S; Rodriguez AE; Sullivan M; Giordano TP
  • Start Page

  • 947
  • End Page

  • 954
  • Volume

  • 29
  • Issue

  • 8