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Using Viral Load Data to Monitor HIV Burden and Treatment Outcomes in the United States

February 7, 2012

Reporting viral load and CD4 counts is a critical first step in calculating community viral load -- a key action step called for in the National HIV/AIDS Strategy.1 In August 2011, the Centers for Disease Control and Prevention (CDC)2 released Guidance on Community Viral Load: Measures, Definitions, and Methods for Calculation to describe the concept of community viral load and provide definitions of and methods for calculating community viral load and related measures. The Guidance proposes common language for viral load (VL) measurements, which include four measures of viral load for an HIV-infected population. The HIV-infected population can be described by five component measures, depending on what information is available on the level of care, viral load, and diagnosis.

The following table shows the four VL measures and their corresponding population component measures:


Viral Load Measures
 Component Measures
Population Viral LoadIn care with undetectable VLIn care with detectable VLIn care, no VL*Diagnosed but not in careUndiagnosed
Community Viral LoadIn care with undetectable VLIn care with detectable VLIn care, no VLDiagnosed but not in care 
In-Care Viral LoadIn care with undetectable VLIn care with detectable VLIn care, no VL  
Monitored Viral LoadIn care with undetectable VLIn care with detectable VL   

* No VL = missing/unknown, for a variety of reasons (e.g., incomplete reporting).


Estimating Measures of Viral Load

Additionally, standardized categorical measures have been defined and can be used to assess the quality of HIV care or the possible transmission potential for the HIV-infected population that is receiving care:


Ability of Surveillance Programs to Calculate Viral Load Measures

Using viral load measures to monitor HIV burden and treatment outcomes does not rest solely with the HIV surveillance system; rather, taking steps to ensure that these measures can be calculated is a function of policy, care and treatment (practice), and surveillance.


Policy


Practice


Surveillance

What increases a surveillance program's ability to estimate viral load?


Current Challenges in Calculating Viral Load Measures


CDC Activities to Address Challenges in Calculating Viral Load Measures


References

  1. National HIV/AIDS Strategy. Accessed January 30, 2012.
  2. Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, HIV Incidence and Case Surveillance Branch.




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