Abstract
Suppressing HIV viral load through daily antiretroviral therapy (ART) substantially reduces the risk of HIV transmission, however, the potential population impact of treatment as prevention (TasP) is mitigated due to challenges with sustained care engagement and ART adherence. For an undetectable viral load (VL) to inform decision making about transmission risk, individuals must be able to accurately classify their VL as detectable or undetectable. Participants were 205 HIV-infected young men who have sex with men (YMSM) and transgender women (TGW) from a large cohort study in the Chicago area. Analyses examined correspondence among self-reported undetectable VL, study-specific VL, and most recent medical record VL. Among HIV-positive YMSM/TGW, 54% had an undetectable VL (< 200 copies/mL) via study-specific laboratory testing. Concordance between self-report and medical record VL values was 80% and between self-report and study-specific laboratory testing was 73%; 34% of participants with a detectable study-specific VL self-reported an undetectable VL at last medical visit, and another 28% reported not knowing their VL status. Periods of lapsed viral suppression between medical visits may represent a particular risk for the TasP strategy among YMSM/TGW. Strategies for frequent viral load monitoring, that are not burdensome to patients, may be necessary to optimize TasP.
Similar content being viewed by others
References
Cohen MS, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.
Rodger AJ, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316(2):171–81.
Bavinton B, et al. HIV treatment prevents HIV transmission in male serodiscordant couples in Australia, Thailand and Brazil. In: International AIDS Society, Paris. 2017.
Das M, et al. Decreases in community viral load are accompanied by reductions in new HIV infections in San Francisco. PLoS ONE. 2010;5(6):e11068.
Montaner JS, et al. Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study. Lancet. 2010;376(9740):532–9.
Solomon SS, et al. Community viral load, antiretroviral therapy coverage, and HIV incidence in India: a cross-sectional, comparative study. Lancet HIV. 2016;3(4):e183–90.
Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. 2016.
World Health Organization. Programmatic update: antiretroviral treatment as prevention (TASP) of HIV and TB. 2012. http://apps.who.int/iris/bitstream/10665/70904/1/WHO_HIV_2012.12_eng.pdf. Accessed 22 Dec 2016.
Gardner EM, et al. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793–800.
Jia Z, et al. Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003–11): a national observational cohort study. Lancet. 2013;382(9899):1195–203.
Bezemer D, et al. A resurgent HIV-1 epidemic among men who have sex with men in the era of potent antiretroviral therapy. AIDS. 2008;22(9):1071–7.
Vernazza P, et al. Les personnes séropositives ne souffrant d’aucune autre MST et suivant un traitement antirétroviral efficace ne transmettent pas le VIH par voie sexuelle. Bulletin des médecins suisses. 2008;89(5):165–9.
Newcomb ME, Mongrella MC, Weis B, McMillen SJ, Mustanski B. Partner disclosure of PrEP use and undetectable viral load on geosocial networking apps: frequency of disclosure and decisions about condomless sex. J Acquir Immune Defic Syndr. 2016;71:200–6. https://doi.org/10.1097/QAI.0000000000000819.
Wolf MS, et al. Relation between literacy and HIV treatment knowledge among patients on HAART regimens. AIDS Care. 2005;17(7):863–73.
Kalichman SC, Rompa D, Cage M. Reliability and validity of self-reported CD4 lymphocyte count and viral load test results in people living with HIV/AIDS. Int J STD AIDS. 2000;11(9):579–85.
Cunningham CO, et al. A comparison of HIV health services utilization measures in a marginalized population: self-report versus medical records. Med Care. 2007;45(3):264–8.
CDC. HIV Surveillance Report, 2015. 2016. http://www.cdc.gov/hiv/library/reports/surveillance/. Accessed 30 Jan 2017.
Zanoni BC, Mayer KH. The adolescent and young adult HIV cascade of care in the United States: exaggerated health disparities. AIDS Patient Care STDS. 2014;28(3):128–35.
Mustanski B, et al. Effects of parental monitoring and knowledge on substance use and HIV risk behaviors among young men who have sex with men: results from three studies. AIDS Behav. 2017 (in press)
Macapagal K, et al. HIV prevention fatigue and HIV treatment optimism among young men who have sex with men. AIDS Educ Prev. 2017;29(4):289–301.
Johnson BT, et al. A network-individual-resource model for HIV prevention. AIDS Behav. 2010;14(Suppl 2):204–21.
Mustanski B, et al. Psychosocial health problems increase risk for HIV among urban young men who have sex with men: preliminary evidence of a syndemic in need of attention. Ann Behav Med. 2007;34(1):37–45.
Duncan SC, Duncan TE, Hops H. Analysis of longitudinal data within accelerated longitudinal designs. Psychol Methods. 1996;1(3):236–48.
Centers for Disease Control and Prevention and Association of Public Health Laboratories. Laboratory testing for the diagnosis of HIV infection: updated recommendations. 2014. http://dx.doi.org/10.15620/cdc.23447. Accessed 11 April 2017.
Centers for Disease Control and Prevention and Association of Public Health Laboratories. Technical update on HIV-1/2 differentiation assays. 2016. https://stacks.cdc.gov/view/cdc/40790. Accessed 11 April 2017.
Torian LV, Xia Q, Wiewel EW. Retention in care and viral suppression among persons living with HIV/AIDS in New York City, 2006–2010. Am J Public Health. 2014;104(9):e24–9.
Yehia BR, et al. Impact of age on retention in care and viral suppression. J Acquir Immune Defic Syndr. 2015;68(4):413–9.
Doshi RK, et al. High rates of retention and viral suppression in the US HIV safety net system: HIV care continuum in the Ryan White HIV/AIDS Program, 2011. Clin Infect Dis. 2015;60(1):117–25.
Cohen SM, et al. HIV viral suppression among persons with varying levels of engagement in HIV medical care, 19 US jurisdictions. J Acquir Immune Defic Syndr. 2014;67(5):519–27.
Chesney MA, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. AIDS Care. 2000;12(3):255–66.
Fung IC, et al. The clinical interpretation of viral blips in HIV patients receiving antiviral treatment: are we ready to infer poor adherence? J Acquir Immune Defic Syndr. 2012;60(1):5–11.
Mustanski B, Starks T, Newcomb ME. Methods for the design and analysis of relationship and partner effects on sexual health. Arch Sex Behav. 2014;43(1):21–33.
Swann G, Newcomb ME, Mustanski B. Validation of the HIV Risk Assessment of Sexual Partnerships (H-RASP): comparison to a 2-month prospective diary study. Arch Sex Behav. 2017 (in press).
CDC. Selected national HIV prevention and care outcomes. 2016. https://www.cdc.gov/hiv/library/slideSets/index.html. Accessed 28 Feb 2017.
Chicago Department of Public Health. HIV/STI surveillance report 2016, Chicago, IL. 2016.
Podsadecki TJ, et al. “White coat compliance” limits the reliability of therapeutic drug monitoring in HIV-1-infected patients. HIV Clin Trials. 2008;9(4):238–46.
Lesko CR, et al. Measuring the HIV care continuum using public health surveillance data in the United States. J Acquir Immune Defic Syndr. 2015;70(5):489–94.
Nosyk B, et al. The cascade of HIV care in British Columbia, Canada, 1996–2011: a population-based retrospective cohort study. Lancet Infect Dis. 2014;14(1):40–9.
Skarbinski J, et al. Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA Intern Med. 2015;175(4):588–96.
Kuhn E, et al. Viral load strategy: impact on risk behaviour and serocommunication of men who have sex with men in specialized care. J Eur Acad Dermatol Venereol. 2016;30(9):1561–6.
Acknowledgements
We acknowledge the contributions of the RADAR study staff, particularly Antonia Clifford, Justin Franz, Roky Truong, Peter Cleary, and Hannah Hudson. Laboratory tests were performed by the Ann & Robert H. Lurie Children’s Hospital Special Infectious Diseases Laboratory in Chicago, Illinois. Viral load data was obtained from some participants from the Chicago Department of Public Health (CDPH), and we thank them for providing these data with the consent of participants under the terms of our data use agreement. CDPH disclaims responsibility for any analysis, interpretations, or conclusions. B.M., R.D., and M.N. conceptualized the study. D.T.R, T.A.R., and E.M. obtained and extracted medical record data. R.T.D. supervised collection of laboratory data. D.T.R. performed statistical analyses. B.M. and D.T.R. drafted the article. All authors reviewed and approved the final article.
Funding
This study was funded by the National Institute on Drug Abuse (U01DA036939). We acknowledge the support of the Third Coast Center for AIDS Research (P30AI117943) and the Northwestern University Clinical and Translational Sciences Institute (UL1TR001422). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Authors declare no conflicts of interest.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Mustanski, B., Ryan, D.T., Remble, T.A. et al. Discordance of Self-report and Laboratory Measures of HIV Viral Load Among Young Men Who Have Sex with Men and Transgender Women in Chicago: Implications for Epidemiology, Care, and Prevention. AIDS Behav 22, 2360–2367 (2018). https://doi.org/10.1007/s10461-018-2112-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-018-2112-7