LB-29. HIV Community Viral Load: recommendations from the CDC Workgroup and examples 
Session: Poster Abstract Session: Late Breaker Posters
Saturday, October 22, 2011
Room: Poster Hall B1
Background: 

“Community viral load” (CVL) is a metric for population-based HIV morbidity and transmission potential, but different methods for calculating and defining “CVL” exist. The National HIV/AIDS Strategy suggested high morbidity areas assess their CVL; and it set goals of levels of undetectable viral load (VL) for subgroups.  We present the recommendations of the CDC CVL Workgroup, finalized August 2011, and 2 HIV surveillance sites’ results.

Method: 

Technical guidance, developed by CDC and state/local HIV surveillance staff, included a conceptual framework of 4 VL Measures (Population, Community, In-Care and Monitored VLs) and 5 component VL measures for “community VL” analyses. Also, categorical VL measures were defined: undetectable (≤50 copies/ml [cpm]), suppressed (≤200 cpm), and high VL (>100K cpm).

HIV-infected persons, aged ≥13 years, alive on December 31 2009 (WV) or December 31 2010 (OR) and their most recent VL during the calendar year were analyzed.  The VL lower limit of detection (VLLLD) by site was determined, 0.5xLLD was used for undetectable results, VL were log10 transformed, and mean (x) and geometric mean (GM) were calculated. Z-test was used for significance testing.

Result: 

Monitored VL in 2010 for OR HIV-infected whites (n=3,626), Hispanics (n=438) and blacks (n=311) were x=1.95 (GM=90, referent), x=2.03 (GM=106, p=0.173) and x=2.26 (GM=180, p<0.001), respectively. Categorical measures of undetectable, suppressed and high VL for whites, Hispanics and blacks were: 54%, 81% and 3%; 56%, 77% and 2%; and 49%, 71% and 5%, respectively.

During 2009, the VLLLD=75 copies/ml in WV.  Among men-who-have-sex-with-men (MSM, n=735) and blacks (n=273) in WV, Monitored VL was x=2.09 (GM=124, referent) and x=2.69 (GM=488, p<0.772), respectively. Component measures of Community VL for MSM were: 42% (n=310) in care and suppressed, 13% (n=95) in care, not suppressed, 3% (n=24) in care, no VL and 42% (n=306) diagnosed but not in care; component measures for blacks were: 22% (n=60), 18% (n=51), 4% (n=10) and 56% (n=152), respectively.

Conclusion: 

VL Measures by race/ethnicity and risk group differed within and between states. Standardized measures, definitions and methods allow HIV surveillance sites and interested parties to make comparisons.


Subject Category: H. HIV/AIDS and other retroviruses

Laurie Kamimoto, MD, MPH, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, Jeff Capizzi, BA, HIV/STD/TB Program, Oregon Department of Human Services, Portland, OR and Mark Miller, BS, 3Division of STD, HIV and Hepatitis, West Virginia Bureau for Public Health, Charleston, WV

Disclosures:

L. Kamimoto, None

J. Capizzi, None

M. Miller, None

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