Discordance of Self-report and Laboratory Measures of HIV Viral Load Among Young Men Who Have Sex with Men and Transgender Women in Chicago: Implications for Epidemiology, Care, and Prevention
Suppressing HIV viral load through daily antiretroviral therapy (ART) substantially reduces the risk of HIV transmission, however, the potential population impact of treatment as prevention (TasP) is mitigated due to challenges with sustained care engagement and ART adherence. For an undetectable viral load (VL) to inform decision making about transmission risk, individuals must be able to accurately classify their VL as detectable or undetectable. Participants were 205 HIV-infected young men who have sex with men (YMSM) and transgender women (TGW) from a large cohort study in the Chicago area. Analyses examined correspondence among self-reported undetectable VL, study-specific VL, and most recent medical record VL. Among HIV-positive YMSM/TGW, 54% had an undetectable VL (< 200 copies/mL) via study-specific laboratory testing. Concordance between self-report and medical record VL values was 80% and between self-report and study-specific laboratory testing was 73%; 34% of participants with a detectable study-specific VL self-reported an undetectable VL at last medical visit, and another 28% reported not knowing their VL status. Periods of lapsed viral suppression between medical visits may represent a particular risk for the TasP strategy among YMSM/TGW. Strategies for frequent viral load monitoring, that are not burdensome to patients, may be necessary to optimize TasP.
KeywordsViral load Undetectable Medical records Treatment as prevention Young MSM
We acknowledge the contributions of the RADAR study staff, particularly Antonia Clifford, Justin Franz, Roky Truong, Peter Cleary, and Hannah Hudson. Laboratory tests were performed by the Ann & Robert H. Lurie Children’s Hospital Special Infectious Diseases Laboratory in Chicago, Illinois. Viral load data was obtained from some participants from the Chicago Department of Public Health (CDPH), and we thank them for providing these data with the consent of participants under the terms of our data use agreement. CDPH disclaims responsibility for any analysis, interpretations, or conclusions. B.M., R.D., and M.N. conceptualized the study. D.T.R, T.A.R., and E.M. obtained and extracted medical record data. R.T.D. supervised collection of laboratory data. D.T.R. performed statistical analyses. B.M. and D.T.R. drafted the article. All authors reviewed and approved the final article.
This study was funded by the National Institute on Drug Abuse (U01DA036939). We acknowledge the support of the Third Coast Center for AIDS Research (P30AI117943) and the Northwestern University Clinical and Translational Sciences Institute (UL1TR001422). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health.
Compliance with Ethical Standards
Conflict of interest
Authors declare no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 3.Bavinton B, et al. HIV treatment prevents HIV transmission in male serodiscordant couples in Australia, Thailand and Brazil. In: International AIDS Society, Paris. 2017.Google Scholar
- 7.Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. 2016.Google Scholar
- 8.World Health Organization. Programmatic update: antiretroviral treatment as prevention (TASP) of HIV and TB. 2012. http://apps.who.int/iris/bitstream/10665/70904/1/WHO_HIV_2012.12_eng.pdf. Accessed 22 Dec 2016.
- 13.Newcomb ME, Mongrella MC, Weis B, McMillen SJ, Mustanski B. Partner disclosure of PrEP use and undetectable viral load on geosocial networking apps: frequency of disclosure and decisions about condomless sex. J Acquir Immune Defic Syndr. 2016;71:200–6. https://doi.org/10.1097/QAI.0000000000000819.CrossRefPubMedPubMedCentralGoogle Scholar
- 17.CDC. HIV Surveillance Report, 2015. 2016. http://www.cdc.gov/hiv/library/reports/surveillance/. Accessed 30 Jan 2017.
- 19.Mustanski B, et al. Effects of parental monitoring and knowledge on substance use and HIV risk behaviors among young men who have sex with men: results from three studies. AIDS Behav. 2017 (in press)Google Scholar
- 24.Centers for Disease Control and Prevention and Association of Public Health Laboratories. Laboratory testing for the diagnosis of HIV infection: updated recommendations. 2014. http://dx.doi.org/10.15620/cdc.23447. Accessed 11 April 2017.
- 25.Centers for Disease Control and Prevention and Association of Public Health Laboratories. Technical update on HIV-1/2 differentiation assays. 2016. https://stacks.cdc.gov/view/cdc/40790. Accessed 11 April 2017.
- 33.Swann G, Newcomb ME, Mustanski B. Validation of the HIV Risk Assessment of Sexual Partnerships (H-RASP): comparison to a 2-month prospective diary study. Arch Sex Behav. 2017 (in press).Google Scholar
- 34.CDC. Selected national HIV prevention and care outcomes. 2016. https://www.cdc.gov/hiv/library/slideSets/index.html. Accessed 28 Feb 2017.
- 35.Chicago Department of Public Health. HIV/STI surveillance report 2016, Chicago, IL. 2016.Google Scholar