Undetectable viral load and HIV transmission dynamics on an individual and population level

2020 ◽  
Vol 33 (1) ◽  
pp. 20-27
Author(s):  
Benjamin R. Bavinton ◽  
Alison J. Rodger
Keyword(s):  
Viral Load ◽  
Hiv Transmission ◽  
Population Level ◽  
Undetectable Viral Load ◽  
Transmission Dynamics

scholarly journals Vulnerability of the Brazilian LGBT population in HIV treatment

2021 ◽  
Vol 15 (10) ◽  
pp. 1481-1488
Author(s):  
Thaisa Fernanda Lourenção Tauyr ◽  
Luciano Garcia Lourenção ◽  
Maria Amélia Zanon Ponce ◽  
Francisco Rosemiro Guimarães Ximenes Neto ◽  
Maria de Lourdes Sperli Geraldes Santos ◽  
...  
Keyword(s):  
High School ◽  
Viral Load ◽  
Hiv Transmission ◽  
Sexual Transmission ◽  
Undetectable Viral Load ◽  
Cross Sectional Study ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Lgbt People

Introduction: Human immunodeficiency virus (HIV) infection affects the lesbian, gay, bisexual, transvestite, and transsexual (LGBT) population. We aimed to identify the indidual vulnerability profile of the LGBT population ling with H/acquired immunodeficiency syndrome (AIDS) and correlate it with the treatment situation. Methodology: This cross-sectional study included 510 LGBT people living with HIV (PLHIV)/AIDS who attended the Complex of Chronic Communicable Diseases of the municipality of São José do Rio Preto, São Paulo, Brazil, between 2008 and 2015. Results: There was a predominance of indiduals who were white (70.2%), male (98.4%), single (87.1%), aged 25–44 years (70.0%), educated up to high school (47.7%), economically acte (91.2%), under treatment (80.8%), having CD4 > 350 cells/mm3 (77.1%), and having undetectable viral load (53.3%). HIV transmission was mainly sexual (97.0%) and most people used drugs (76.5%). There was a weak correlation between the variables ‘in treatment’ and acte occupation (r = 0.148, p = 0.001), single marital status (r = 0.128, p = 0.004), white race/colour (r = 0.117, p = 0.008), high school education (r = 0.111, p = 0.012), sexual transmission (r = 0.222, p = 0.000), drug use (r = 0.087, p = 0.049), and CD4 > 350 cells/mm3 (r = 0.118, p = 0.008); and strong correlation between the variables ‘in treatment’ and undetectable viral load (r = -0.937, p = 0.113). Conclusions: The characteristics of the indidual vulnerability of LGBT people involve, among other aspects, issues of gender and social exclusion, a situation that is part of the daily life of PLHIV/AIDS in many scenarios and territories. This can be alleviated with a network of social and health support and effecte and efficient, protecte, attitudinal, and behavioural public policies.

scholarly journals 1713. Factors Associated with Viral Rebound post Blip in Patients from a Community HIV Clinic

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S840-S840
Author(s):  
Eduardo Sanchez ◽  
Jody Borgman ◽  
Aviva Joffe ◽  
Catherine Holdsworth
Keyword(s):  
Multivariate Analysis ◽  
Viral Load ◽  
Hiv Transmission ◽  
Retrospective Chart Review ◽  
Undetectable Viral Load ◽  
Transmission Factor ◽  
Viral Rebound ◽  
Hiv Viral Load ◽  
Factors Associated ◽  
Average Value

Abstract Background Blips are detectable increases in the HIV viral load (VL) that occur after therapy has effectively suppressed the virus to an undetectable level. There is no clear etiology for the development of blips. The association between blips and viral failure remains unclear. Methods This retrospective chart review aimed to clinically characterize patients who developed blips in a community HIV clinic in north Philadelphia between 2014-2018. A blip was defined as a single detectable VL < 500 copies/mL which appears between two undetectable VL measurements. Multivariate analysis was performed to examine the relationship of certain variables and viral rebound (VR) in patients with blips. Viral rebound was defined as post blip VL > 200 copies/mL that was not followed by an undetectable viral load. Results Of a total of 666 patients, 225 (33.7%) had at least 1 blip. 59% were male and 41% were female. The majority were African American (84.4%). Sixty seven percent were heterosexuals and 25.7% were MSM. Analyzing CD4 counts at the moment of blip, 68% had >500 cells/mm3. The average value of the blips was 85 copies/mL with 48.8% of the patients having a blip between 20-50 copies/mL. Most of the patients were on INSTIs (49.5%) followed by NNRTIs (35.6%). Of the 225 patients, 148 had at least 1 year of follow up post-blip. Those who were followed for less than 1-year post-blip were not included in the statistical analysis to find potential factors associated with VR. Thirty-two (21.6%) patients developed rebound. The multivariate analysis showed that being male and having a higher blip value were factors associated to increased likelihood of VR. Factors associated to decreased likelihood of rebound were the use of NNRTIs at blip and an HIV transmission factor that was not heterosexual sex (MSM and IDU). All of these associations were noted to be statistically significant. Conclusion The variables that were found to be associated to viral rebound could help guide clinicians during the surveillance of patient’s with blips. Further research in larger cohorts would help clarify the role of these variables in patients who develop treatment failure. Disclosures All Authors: No reported disclosures

Interactions between highly active antiretroviral therapy and over-the-counter agents: a cautionary note

2021 ◽  
Vol 14 (1) ◽  
pp. e236655
Author(s):  
Jerome Federspiel ◽  
Melanie J Bukhari ◽  
Matthew M Hamill
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Viral Suppression ◽  
Hiv Transmission ◽  
Undetectable Viral Load ◽  
Pregnant Patient ◽  
Access To Treatment ◽  
Highly Active ◽  
In Pregnancy

Highly active antiretroviral therapy (HAART) has dramatically lowered rates of mother-to-child HIV transmission among patients with access to treatment. Barriers to complete viral suppression increase rates of transmission, even with only low levels of viral replication. Here, we present the case of a pregnant patient who developed a detectable viral load in pregnancy, thought to be related to calcium supplement consumption or emesis while using a dolutegravir-based HAART regimen. Ultimately, with adjustments, the patient again reached an undetectable viral load and had an uncomplicated perinatal and neonatal outcome. We discuss new data on the use of dolutegravir in pregnancy and precautions for maintaining viral suppression while on antiretroviral therapy in pregnancy.

scholarly journals Breastfeeding with HIV: An Evidence-Based Case for New Policy

2019 ◽  
Vol 47 (1) ◽  
pp. 152-160 ◽  
Author(s):  
Marielle S. Gross ◽  
Holly A. Taylor ◽  
Cecilia Tomori ◽  
Jenell S. Coleman
Keyword(s):  
Viral Load ◽  
Harm Reduction ◽  
Hiv Transmission ◽  
Undetectable Viral Load ◽  
Perinatal Transmission ◽  
Sudden Infant ◽  
National Guidelines ◽  
Women Living With Hiv ◽  
Perinatal Hiv ◽  
Living With Hiv

To help eliminate perinatal HIV transmission, the US Department of Health and Human Services recommends against breastfeeding for women living with HIV, regardless of viral load or combined antiretroviral therapy (cART) status. However, cART radically improves HIV prognosis and virtually eliminates perinatal transmission, and breastfeeding's health benefits are well-established. In this setting, pregnancy is increasing among American women with HIV, and a harm reduction approach to those who breastfeed despite extensive counseling is suggested. We assess the evidence and ethical justification for current policy, with attention to pertinent racial and health disparities. We first review perinatal transmission and breastfeeding data relevant to US infants. We compare hypothetical risk of HIV transmission from breastmilk to increased mortality from sudden infant death syndrome, necrotizing enterocolitis and sepsis from avoiding breastfeeding, finding that benefits may outweigh risks if mothers maintain undetectable viral load on cART. We then review maternal health considerations. We conclude that avoidance of breastfeeding by women living with HIV may not maximize health outcomes and discuss our recommendation for revising national guidelines in light of autonomy, harm reduction and health inequities.

scholarly journals The role of HIV viral load in mathematical models of HIV transmission and treatment: a review

2020 ◽  
Vol 5 (1) ◽  
pp. e001800 ◽  
Author(s):  
Tracy Glass ◽  
Landon Myer ◽  
Maia Lesosky
Keyword(s):  
Viral Load ◽  
Mathematical Models ◽  
Hiv Transmission ◽  
Simulation Models ◽  
Population Level ◽  
Hiv Treatment ◽  
Hiv Viral Load ◽  
Hiv Epidemiology ◽  
The Impact

IntroductionHIV viral load (VL) is accepted as a key biomarker in HIV transmission and pathogenesis. This paper presents a review of the role of VL testing in mathematical models for HIV prevention and treatment.MethodsA search for simulation models of HIV was conducted in PubMed, yielding a total of 1210 studies. Publications before the year 2000, studies involving animals and analyses that did not use mathematical simulations were excluded. The full text of eligible articles was sourced and information about the intervention and population being modelled, type of modelling approach and disease monitoring strategy was extracted.Results and discussionA total of 279 studies related to HIV simulation models were included in the review, though only 17 (6%) included consideration of VL or VL testing and were evaluated in detail. Within the studies that included assessment of VL, routine monitoring was the focus, and usually in comparison to alternate monitoring strategies such as clinical or CD4 count-based monitoring. The majority of remaining models focus on the impact or delivery of antiretroviral therapy (n=68; 27%), pre-exposure prophylaxis (n=28; 11%) and/or HIV testing (n=24; 9%) on population estimates of HIV epidemiology and exclude consideration of VL. Few studies investigate or compare alternate VL monitoring frequencies, and only a small number of studies overall (3%) include consideration of vulnerable population groups such as pregnant women or infants.ConclusionsThere are very few simulations of HIV treatment or prevention that include VL measures, despite VL being recognised as the key determinant of both transmission and treatment outcomes. With growing emphasis on VL monitoring as key tool for population-level HIV control, there is a clear need for simulations of HIV epidemiology based on VL.

scholarly journals Treatment of HIV-associated facial lipoatrophy: impact on infection progression assessed by viral load and CD4 count

2013 ◽  
Vol 88 (4) ◽  
pp. 570-577 ◽  
Author(s):  
Flávia Machado Gonçalves Soares ◽  
Izelda Maria Carvalho Costa
Keyword(s):  
Viral Load ◽  
Disease Progression ◽  
Statistical Significance ◽  
Undetectable Viral Load ◽  
Fat Distribution ◽  
Cd4 Count ◽  
Before And After ◽  
Facial Lipoatrophy ◽  
A Prospective Study ◽  
The Impact

BACKGROUND: HIV/AIDS-Associated Lipodystrophy Syndrome includes changes in body fat distribution, with or without metabolic changes. The loss of fat from the face, called facial lipoatrophy, is one of the most stigmatizing signs of the syndrome.OBJECTIVES:To evaluate the effect of FL treatment using polymethylmethacrylate (PMMA) implants on disease progression, assessed by viral load and CD4 cell count.METHODS: This was a prospective study of 44 patients treated from July 2009 to December 2010. Male and female patients, aged over 18 years, with clinically detectable FL and who had never been treated were included in the study. PMMA implantation was done to fill atrophic areas. Laboratory tests were conducted to measure viral load and CD4 count before and after treatment.RESULTS: Of the 44 patients, 72.72% were male and 27.27% female, mean age of 44.38 years. Before treatment, 82% of patients had undetectable viral load, which increased to 88.6% after treatment, but without statistical significance (p = 0.67). CD4 count before treatment ranged from 209 to 1293, averaging 493.97. After treatment, the average increased to 548.61. The increase in CD4 count after treatment was statistically significant with p = 0.02.CONCLUSION: The treatment of FL with PMMA implants showed a statistically significant increase in CD4 count after treatment, revealing the impact of FL treatment on disease progression. Viral load before and after treatment did not vary significantly.

Factors associated with HIV care and treatment cascade in Rio Grande do Sul, Brazil, 2014–2017: A cross-sectional study

2021 ◽  
pp. 095646242097594
Author(s):  
Guilherme B Shimocomaqui ◽  
Craig S Meyer ◽  
Maria L Ikeda ◽  
Elson Romeu Farias ◽  
Tonantzin R Gonçalves ◽  
...  
Keyword(s):  
Viral Load ◽  
Rio Grande ◽  
Undetectable Viral Load ◽  
Cross Sectional Study ◽  
Hiv Care ◽  
Rio Grande Do Sul ◽  
Sectional Study ◽  
Cross Sectional ◽  
Treatment Cascade ◽  
Care And Treatment

In 2018, Rio Grande do Sul (RS) had some of the highest HIV/AIDS rates in Brazil, and we did not find any studies about the HIV care and treatment cascade (HCTC) related to this state. We aimed to estimate the indicators of HCTC of RS, Brazil, and associated factors. A cross-sectional study with all people living with HIV (PLWH) in RS between 1 January 2014 and 31 December 2017 was conducted using a national database which registers all HIV notifications, CD4 and viral load laboratory data and antiretroviral therapy (ART) usage in the public health system. We considered sex, age, education, race, year of HIV diagnosis, and health region as predictor factors, and defined linkage to care, retention to care, being on ART, and having undetectable viral load as the HCTC indicators. Descriptive analysis and multivariable logistic regression were performed using Stata 15.2. A total of 116,121 PLWH were diagnosed, 79,959 were linked to care, 72,117 retained in care, 69,219 on ART, and 54,857 had undetectable viral load from 2014 to 2017. We observed greatest attrition for younger age, non-white, and lower education in all HCTC indicators. Women are more likely to have undetectable viral load (OR = 1.04, 95% CI: 1.01–1.07), even though they are less likely to be retained to care (OR = 0.92; 95% CI: 0.89–0.96) and on ART (OR = 0.82; 95% CI: 0.78–0.86). Although all HCTC indicators have increased over the period and the “test and treat” policy indicates improvements in ART and in undetectable viral load outcomes, evidence suggests specific attrition and disparities such as those related to HIV healthcare facilities should be addressed. These findings may be used by researchers, health professionals, and policymakers in order to investigate and implement interventions to better engage PLWH across the HCTC.

scholarly journals Undetectable viral load within the mastoid during cochlear implantation in a patient with COVID-19

2021 ◽  
pp. 100273
Author(s):  
Kyle S. Kimura ◽  
Miriam R. Smetak ◽  
Michael H. Freeman ◽  
Christopher T. Wootten
Keyword(s):  
Viral Load ◽  
Cochlear Implantation ◽  
Undetectable Viral Load

scholarly journals 520. Longitudinal Analysis of SARS-CoV-2 Viruses in Hospitalized Adults

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S325-S326
Author(s):  
Lacy Simons ◽  
Ramon Lorenzo-Redondo ◽  
Hannah Nam ◽  
Scott C Roberts ◽  
Michael G Ison ◽  
...  
Keyword(s):  
Viral Load ◽  
Genome Sequencing ◽  
Viral Genome ◽  
Temporal Dynamics ◽  
Population Level ◽  
Hospital Staff ◽  
Therapeutic Interventions ◽  
Viral Loads ◽  
Qrt Pcr ◽  
Over Time

Abstract Background The rapid spread of SARS-CoV-2, the causative agent of Coronavirus disease 2019 (COVID-19), has been accompanied by the emergence of viral mutations, some of which may have distinct virological and clinical consequences. While whole genome sequencing efforts have worked to map this viral diversity at the population level, little is known about how SARS-CoV-2 may diversify within a host over time. This is particularly important for understanding the emergence of viral resistance to therapeutic interventions and immune pressure. The goal of this study was to assess the change in viral load and viral genome sequence within patients over time and determine if these changes correlate with clinical and/or demographic parameters. Methods Hospitalized patients admitted to Northwestern Memorial Hospital with a positive SARS-CoV-2 test were enrolled in a longitudinal study for the serial collection of nasopharyngeal specimens. Swabs were administered to patients by hospital staff every 4 ± 1 days for up to 32 days or until the patients were discharged. RNA was extracted from each specimen and viral loads were calculated by quantitative reverse transcriptase PCR (qRT-PCR). Specimens with qRT-PCR cycle threshold values less than or equal to 30 were subject to whole viral genome sequencing by reverse transcription, multiplex PCR, and deep sequencing. Variant populations sizes were estimated and subject to phylogenetic analysis relative to publicly available SARS-CoV-2 sequences. Sequence and viral load data were subsequently correlated to available demographic and clinical data. Results 60 patients were enrolled from March 26th to June 20th, 2020. We observed an overall decrease in nasopharyngeal viral load over time across all patients. However, the temporal dynamics of viral load differed on a patient-by-patient basis. Several mutations were also observed to have emerged within patients over time. Distribution of SARS-CoV-2 viral loads in serially collected nasopharyngeal swabs in hospitalized adults as determined by qRT-PCR. Samples were collected every 4 ± 1 days (T#1–8) and viral load is displayed by log(copy number). Conclusion These data indicate that SARS-CoV-2 viral loads in the nasopharynx decrease over time and that the virus can accumulate mutations during replication within individual patients. Future studies will examine if some of these mutations may provide fitness advantages in the presence of therapeutic and/or immune selective pressures. Disclosures Michael G. Ison, MD MS, AlloVir (Consultant)

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