scholarly journals Impact of Viral Load Monitoring on Retention and Viral Suppression: A Regression Discontinuity Analysis of South Africa’s National Laboratory Cohort

2020 ◽  
Vol 189 (12) ◽  
pp. 1492-1501
Author(s):  
Alyssa F Harlow ◽  
Jacob Bor ◽  
Alana T Brennan ◽  
Mhairi Maskew ◽  
William MacLeod ◽  
...  
Keyword(s):  
Viral Load ◽  
South African ◽  
Viral Suppression ◽  
Regression Discontinuity ◽  
Risk Difference ◽  
Repeat Testing ◽  
Viral Loads ◽  
Viral Load Monitoring ◽  
Load Monitoring ◽  
To Receive

Abstract South African guidelines recommend repeat viral load testing within 6 months when human immunodeficiency virus (HIV) viral loads exceed 1,000 copies/mL. We assessed whether South African facilities follow viral load monitoring guidelines and whether guidelines improve HIV-related outcomes, using a regression discontinuity design in a national HIV cohort of 174,574 patients (2013–2015). We assessed whether patients with viral loads just above versus just below 1,000 copies/mL were more likely to receive repeat testing in 6 months, and we compared differences in clinic transfers, retention, and viral suppression. The majority (67%) of patients with viral loads of >1,000 copies/mL did not receive repeat testing within 6 months, and these patients were 8.0% (95% confidence interval (CI): 6.2, 9.7) more likely to receive repeat testing compared with ≤1,000 copies/mL. Eligibility for repeat testing (>1,000 copies/mL) was associated with greater 12-month retention (risk difference = 2.9%, 95% CI: 0.6, 5.2) and combined suppression and retention (risk difference = 5.8%, 95% CI: 3.0, 8.6). Patients with viral loads of >1,000 copies/mL who actually received repeat testing were 85.2% more likely to be both retained and virally suppressed at 12 months (95% CI: 35.9, 100.0). Viral load monitoring might improve patient outcomes, but most patients with elevated viral loads do not receive monitoring within recommended timelines.

scholarly journals High levels of viral load monitoring and viral suppression under Treat All in Rwanda – a cross‐sectional study

2020 ◽  
Vol 23 (6) ◽  
Author(s):  
Jonathan Ross ◽  
Muhayimpundu Ribakare ◽  
Eric Remera ◽  
Gad Murenzi ◽  
Athanase Munyaneza ◽  
...  
Keyword(s):  
Viral Load ◽  
Viral Suppression ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Viral Load Monitoring ◽  
Load Monitoring ◽  
Treat All

scholarly journals Response to a Protease-Inhibitor (Ritonavir)-Containing Combination Antiretroviral Regimen in HIV-Infected Children

2003 ◽  
Vol 14 (2) ◽  
pp. 89-93
Author(s):  
Upton D Allen ◽  
Normand Lapointe ◽  
Stanley E Read ◽  
Jack C Forbes ◽  
Susan M King ◽  
...  
Keyword(s):  
Viral Load ◽  
Significant Proportion ◽  
Limited Data ◽  
Median Viral Load ◽  
Cd4 Counts ◽  
Viral Loads ◽  
Viral Load Monitoring ◽  
Load Monitoring ◽  
Perinatally Acquired ◽  
Combination Regimens

INTRODUCTION: The number of antiretroviral agents available for children who are failing existing therapy is limited. Data are lacking on the use of various combination regimens and the resulting viral load dynamics in such children.METHODS: Between March 1998 and March 2000, HIV-infected children younger than 18 years of age were studied in an open trial. The study regimen included ritonavir, with at least two drugs to which the virus was known or presumed to be sensitive. subjects were ritonavir-naive and were included if they had high viral loads while receiving antiretroviral therapy. Patients had clinical assessments, CD4 counts and viral load monitoring.RESULTS: Fifteen antiretroviral-experienced HIV-infected children were enrolled. Approximately 87% (13 of 15) had perinatally-acquired HIV; median age was 7.9 years (range 1.6 to 14.8). At enrolment, the median CD4 count was 557 cells/mm3(range 57 to 1702) and the median viral load was 72,600 copies/mL (range 3626 to 796,440). The majority of children (73.3%) had increases in CD4 counts within 12 weeks. During this period, the median increase in CD4 counts over baseline was 30.0%. Approximately 73% (eight of 11) of subjects with initial improvements in CD4 counts had sustained increases at 32 to 48 weeks. Over the first 12 weeks, 60% (nine of 15) had greater than 0.5 log10decreases in viral load. The improvement was sustained in 88.9% (eight of nine) of these patients at 32 to 48 weeks. Three patients discontinued therapy due to taste aversion.CONCLUSIONS: Among pediatric patients with high viral loads while on existing therapy, the ritonavir-containing regimen was generally well tolerated. In a significant proportion of patients, modification of therapy was associated with sustained improvements in viral loads and CD4 counts over 32 to 48 weeks.

Viral Load Monitoring for People Living with HIV in the Era of Test and Treat: Progress Made and Challenges Ahead – A Systematic Review

2021 ◽  
Author(s):  
Minh D. Pham ◽  
Huy V. Nguyen ◽  
David Anderson ◽  
Suzanne Crowe ◽  
Stanley Luchters
Keyword(s):  
Systematic Review ◽  
Viral Load ◽  
Viral Suppression ◽  
Search Strategy ◽  
People Living With Hiv ◽  
Community Based ◽  
Viral Load Monitoring ◽  
Load Monitoring ◽  
Living With Hiv

Abstract Background Treatment of HIV with antiretroviral therapy (ART) can improve the health of people living with HIV (PLHIV), stop onward transmission of HIV and effectively prevent the spread of the virus. In 2016, we conducted a systematic review to assess the feasibility of treatment monitoring for PLHIV on ART in low and middle-income countries (LMICs), in line with the 90-90-90 treatment target. By 2020, global estimates suggest the 90-90-90 target remains unattainable in many LMICs. This study aims to review the progress and identify needs for public health interventions to improve viral load monitoring and viral suppression for PLHIV in LMICs. Methods A literature search was conducted using an update of the initial search strategy developed for the 2016 review with key search terms relevant to HIV treatment and care, decentralization and viral load monitoring. Electronic databases (Medline and PubMed) were searched to identify relevant literature published in English between Dec 2015 and August 2021. The primary outcome was initial viral load (VL) monitoring (the proportion of PLHIV on ART and eligible for VL monitoring who received a VL test). Secondary outcomes included follow-up VL monitoring (the proportion of PLHIV who received a follow-up VL after an initial elevated VL test), confirmation of treatment failure (the proportion of PLHIV who had two consecutive elevated VL results) and switching treatment regimen rates (the proportion of PLHIV who switched treatment regimen after confirmation of treatment failure). Results The search strategy identified 1984 non-duplicate records, of which 34 studies were included in the review. More than 85% (29/34) of included studies were conducted in 11 sub-Saharan African countries (SSA) using routinely collected program data; two studies were conducted among key populations (KPs) attending research clinics. Sixty per cent (20/34) of these studies were designed to evaluate VL monitoring and/or VL cascade among PLHIV on ART, and most were published in 2019–2021. Marked variations in initial VL monitoring coverage were reported across study settings/countries (range: 12–93% median: 74% IQR: 46-82%) and study populations (adults (range: 25–96%, median: 67% IQR: 50-84%), children, adolescents/young people (range: 2–94%, median: 72% IQR: 47-85%), and pregnant women (range: 32–82%, median: 57% IQR: 43-71%)). Community-based models reported higher VL monitoring (median: 85%, IQR: 82%-88%) compared to decentralised care at primary health facility (median: 64%, IRQ: 48%-82%). Suboptimal uptake of follow-up VL monitoring and low regimen switching rates were observed. Conclusions There was a marked increase in the number of studies of VL monitoring for PLHIV on ART in LMICs over the past five years. Substantial gaps in VL coverage across study settings and study populations were evident, with limited data availability outside of SSA and in KPs. Further research is needed to fill the data gaps. Development and implementation of innovative, community-based interventions are required to improve VL monitoring and address the “failure cascade” in PLHIV on ART who fail to achieve viral suppression.

scholarly journals SARS-CoV-2 viral load monitoring by extraction-free testing of saliva

2021 ◽  
Author(s):  
Yue Qiu ◽  
Ling Lu ◽  
Dexiang Gao ◽  
Patrick McGrath ◽  
Chann Han ◽  
...  
Keyword(s):  
Viral Load ◽  
Clinical Sensitivity ◽  
Viral Loads ◽  
Clinical Assay ◽  
Performance Variability ◽  
Assay Performance ◽  
Viral Load Monitoring ◽  
Load Monitoring ◽  
Droplet Pcr ◽  
Polymerase Chain

Real-time quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) remains the foundation of SARS-CoV-2 testing due to its accessibility, scalability, and superior assay performance. Variability in specimens and methods prevent standardization of RT-qPCR assays and reliable quantitative reporting to assess viral load. We developed an extraction-free RT-qPCR assay for detection of SARS-CoV-2 in saliva and monitored viral load until convalescence in COVID-19 patients. Comparison of 231 matched anterior nares swab and saliva specimens demonstrated that extraction-free testing of saliva has equivalent analytical and clinical assay performance compared to testing of RNA extracts from either anterior nares or saliva specimens. Analysis of specimen pairs revealed higher viral loads in the nasal cavity compared to the oral cavity, although this difference did not impact clinical sensitivity for COVID-19. Extraction-free testing of a combination specimen consisting of both nasal swab and saliva is also demonstrated. Assessment of viral load by RT-qPCR and parallel digital droplet PCR (ddPCR) revealed that cycle threshold (Ct) values less than approximately 30 correlated well with viral load, whereas Ct values greater than 30 correspond to low viral loads <10 copies/uL. Therefore, extraction-free saliva testing maximizes testing efficiency without compromising assay performance and approximates viral loads >10 copies/uL. This technology can facilitate high-throughput laboratory testing for SARS-CoV-2, monitor viral load in individual patients, and assess efficacy of therapies for COVID-19.

Quantitative viral load monitoring and cidofovir therapy for the management of BK virus-associated nephropathy in children and adults1

2003 ◽  
Vol 75 (1) ◽  
pp. 105-112 ◽  
Author(s):  
Abhay Vats ◽  
Ron Shapiro ◽  
Parmjeet Singh Randhawa ◽  
Velma Scantlebury ◽  
Acar Tuzuner ◽  
...  
Keyword(s):  
Viral Load ◽  
Bk Virus ◽  
Viral Load Monitoring ◽  
Load Monitoring

HIV-1 RNA Viral Load Monitoring in HIV-Infected Drug Users on Antiretroviral Therapy

2002 ◽  
Vol 29 (3) ◽  
pp. 270-274
Author(s):  
Christine Laine ◽  
Daozhi Zhang ◽  
Walter W. Hauck ◽  
Barbara J. Turner
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Drug Users ◽  
Viral Load Monitoring ◽  
Load Monitoring ◽  
Hiv 1
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