Quantitative RNA

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Quantitative RNA
Data reflected in this report are based solely on the collection of samples submitted to LabCorp for testing. Refer to the limitations section of this report for additional guidance in interpreting the data. Human Immunodeficiency Virus RNA Quantitation HIV viral load testing using the Taqman real-time assay was introduced at LabCorp in January of 2009. Between Feb 1 and December 31, 2009, 41% of samples tested had no detectable HIV RNA and an additional 16% had HIV detected at a level below the quantifiable limit of 48 copies/ml (Figure 9).

Viral loads over 100,000 copies/ml, which may be associated with more rapid disease progression, were seen in 5.3% of cases. Patients with viral RNA levels above 100,000 copies/ml are more infectious and contribute disproportionately to transmission of HIV infection. This is particularly notable in acute infection, prior to full sero-conversion, when viral levels are especially high and the risk of HIV transmission is greatest.1 Examination of distribution of viral levels in various age groups (Figure 10)

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demonstrates the highest proportion of undetectable viral loads (well controlled HIV infection) in older individuals >50 years old, where 48% had no detectable virus (P<0.0001). This contrasts with other adults (18-50 yrs) where viral suppression to below detectable level was 37%. Lower viral levels in individuals >50 yrs may be attributable to greater compliance with drug therapy or to reduced inclusion of newly infected individuals, for whom treatment has not yet been initiated. There were no significant differences in viral levels by gender. Successful treatment and/or fewer new HIV infections, as demonstrated by a higher proportion of undetectable virus, were more likely to be seen in less racially mixed geographic areas and in higher median income areas, 45% in areas >75% Caucasian (P<0.0001) and 44% in median income areas > $50,000 (P<0.0001) (Figure 11)

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and (Figure 12).

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Our data confirm observations of others showing disparities in health care in minority populations and in lower income populations.2,3 Clinic specialty analysis of viral load distributions indicates the lowest proportion of undetectable viral loads in samples coming from prisons where only about 30% had an undetectable viral load (P<0.0001) (See Table 2).

Multiple factors potentially contribute to these observations, including lack of access to healthcare as well as other socioeconomic factors that disproportionately affect this population, leading to fewer cases of well controlled infection and a higher proportion of new infections. The HIV undetectable viral load map (Figure 13)

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provides the percentage of undetectable viral loads in samples from states with sufficient test records (>50) to analyze. Several Southeastern states show a lower percentage of undetectable viral levels, which may reflect higher rates of new infections and/or lower levels of well controlled HIV infection.

References:

1.

Miller WC, Rosenberg NE, Rutstein SE, Powers KA. Role of acute and early HIV infection in the sexual transmission of HIV. Curr Opin HIV AIDS; 2010 5(4):277-82.

2. 3.

Cargill VA, Stone VE. HIV/AIDS: a minority health issue. Med Clin North Am 2005; 89(4): 895-912. Kempf MC, McLeod J, Boehme AK, et al. A qualitative study of the barriers and facilitators to retention-in-care among HIV-positive women in the rural southeastern United States: implications for targeted interventions. AIDS Patient Care STDS. 2010; 24(8): 515-520.

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