HIV/AIDS Division, San Francisco General Hospital, University of California, San Francisco (UCSF), San Francisco, CA 94143-0874, USA.
Clin Infect Dis. 2013 Feb;56(4):598-605. doi: 10.1093/cid/cis881. Epub 2012 Dec 12.
Population-based human immunodeficiency virus type 1 (HIV-1) RNA levels (viral load [VL]) are proposed metrics for antiretroviral therapy (ART) program effectiveness. We estimated population-based HIV RNA levels using a fingerprick-based approach in a rural Ugandan community implementing rapid ART scale-up.
A fingerprick-based HIV RNA measurement technique was validated against standard phlebotomy. This technique was deployed during a 5-day community-wide health campaign in a 6300-person community. Assessments included rapid HIV antibody testing, VL, and CD4+ T-cell count via fingerprick. We estimated population HIV RNA levels and the prevalence of undetectable RNA, assessed predictors of VL via linear regression, and mapped RNA levels within community geographic units.
During the community-wide health campaign, 179 of 2282 adults (7.8%) and 10 of 1826 children (0.5%) tested seropositive for HIV. Fingerprick VL was determined in 174 of 189 HIV-positive persons (92%). The mean log(VL) was 3.67 log (95% confidence interval [CI], 3.50-3.83 log copies/mL), median VL was 2720 copies/mL (interquartile range, <486-38 120 copies/mL), and arithmetic mean VL was 64 064 copies/mL. Overall, 64 of 174 of individuals had undetectable RNA (37% [95% CI, 30%-44%]), 24% had VL 486-10 000; 25% had VL 10 001-100 000; and 15% had VL>100 000 copies/mL. Among participants taking ART, 83% had undetectable VL.
We developed and implemented a fingerprick VL testing method and provide the first report of population HIV RNA levels in Africa. In a rural Ugandan community experiencing ART scale-up, we found evidence of population-level ART effectiveness, but found a substantial population to be viremic, in need of ART, and at risk for transmission.
基于人群的人类免疫缺陷病毒 1 型（HIV-1）RNA 水平（病毒载量[VL]）被提议作为抗逆转录病毒疗法（ART）项目效果的衡量标准。我们使用基于指尖的方法在一个正在快速扩大抗逆转录病毒治疗的乌干达农村社区中估算基于人群的 HIV RNA 水平。
我们对手指采血 HIV RNA 测量技术进行了验证，该技术与标准静脉采血进行了对比。该技术在一个 6300 人的社区进行的为期 5 天的社区范围的健康运动中得到了应用。评估包括快速 HIV 抗体检测、VL 和通过指尖进行的 CD4+T 细胞计数。我们估算了人群 HIV RNA 水平和无法检测到 RNA 的比例，通过线性回归评估了 VL 的预测因素，并在社区地理单元内绘制了 RNA 水平。
在社区范围的健康运动中，2282 名成年人中有 179 人（7.8%）和 1826 名儿童中有 10 人（0.5%）HIV 血清学检测阳性。在 189 名 HIV 阳性者中，有 174 人（92%）确定了指尖 VL。平均对数 VL（log VL）为 3.67（95%置信区间[CI]，3.50-3.83 对数拷贝/ml），中位数 VL 为 2720 拷贝/ml（四分位距，<486-38120 拷贝/ml），算术平均 VL 为 64064 拷贝/ml。总体而言，64 名（37%[95%CI，30%-44%]）患者的 RNA 不可检测，24%的患者 VL 为 486-10000；25%的患者 VL 为 10001-100000；15%的患者 VL>100000 拷贝/ml。在接受 ART 的参与者中，83%的患者 VL 不可检测。
我们开发并实施了一种指尖 VL 检测方法，并提供了非洲首次人群 HIV RNA 水平的报告。在一个经历 ART 大规模推广的乌干达农村社区中，我们发现了人群层面 ART 效果的证据，但发现大量人群仍存在病毒血症，需要接受 ART 治疗，并且有传播的风险。
