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

Gary Marks, Lytt I. Gardner, Charles E. Rose, Anne Zinski, Richard D. Moore, Susan Holman, Allan E. Rodriguez, Meg Sullivan, Thomas P. Giordano

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)947-954
Number of pages8
JournalAIDS (London, England)
Volume29
Issue number8
DOIs
StatePublished - May 15 2015

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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    Marks, G., Gardner, L. I., Rose, C. E., Zinski, A., Moore, R. D., Holman, S., Rodriguez, A. E., Sullivan, M., & Giordano, T. P. (2015). Time above 1500 copies: a viral load measure for assessing transmission risk of HIV-positive patients in care. AIDS (London, England), 29(8), 947-954. https://doi.org/10.1097/QAD.0000000000000640