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Updated: Mar 21, 2026
Amplifying and Quantifying HIV-1 RNA in HIV Infected Individuals with Viral Loads Below the Limit of Detection by Standard Clinical Assays
Published on: September 26, 2011
Associations between HIV-RNA-based indicators and virological and clinical outcomes
Kamilla G Laut1, Leah C Shepherd, Court Pedersen
1aCHIP, Centre for Health & Infectious Diseases Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark bHIV Epidemiology and Biostatistics Unit, Department Infection and Population Health, University College London, London, United Kingdom cDepartment of Infectious Diseases, Odense University Hospital, Odense, Denmark dImmunologische Ambulanz, University Hospital Bonn, Bonn, Germany e2nd Department of Internal Medicine, Hippokration General Hospital, University of Athens, Athens, Greece fEpidemiology and Healthcare, Gomel Regional Centre for Hygiene, Gomel, Belarus gDepartment of Infectious, Chest diseases, Dermatovenerology and Allergology, Vilnius University; Centre of Infectious Diseases, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania hDepartment of Infectious Diseases, Medical University Gdansk, Gdansk, Poland iThe Guide Clinic, St James' Hospital, Dublin, Ireland.
Objectives:
To evaluate and compare the performance of six HIV-RNA-based quality of care indicators for predicting short-term and long-term outcomes.
Design:
Multinational cohort study.
Methods:
We included EuroSIDA patients on antiretroviral therapy (ART) with at least three viral load measurements after baseline (the latest of 01/01/2001 or entry into EuroSIDA). Using multivariate Poisson regression, we modelled the association between short-term (resistance, triple-class failure) and long-term (all-cause mortality, any AIDS/non-AIDS clinical event) outcomes and the indicators: viraemia copy years; consecutive months with viral load ≥ 50 copies/ml; percentage of time on ART spent fully suppressed (%FS); stable on ART; 48 weeks snapshot; and current viral load. Indicators were compared using area under the ROC curve (AUC) and different measures of model fit.
Results:
Adjusted incidence rate ratios for all outcomes tended to increase with increasing viraemia copy years, number of consecutive months with viral load ≥ 50 copies/ml, current viral load and with lower %FS, but the gradient of increased risk was weak across strata. None of the indicators reliably identified those at risk of long-term outcomes (AUC 0.54-0.58), but performed consistently better with short-term outcomes [triple class failure (AUC 0.67-0.76) and resistance (AUC 0.64-0.79)]. Goodness of fit varied with the outcome evaluated, but differences between indicators were small.
Conclusion:
Differences between quality of care indicators were small and no indicator performed consistently better than current viral load. Given the simplicity in assessing and interpreting this indicator, we propose to use current viral load when HIV-RNA-based indicators are used to evaluate the efficacy of ART programs.
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