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Human immunodeficiency virus type 1 (HIV-1) RNA levels (viral load [VL]) are considered to be an indicator of the efficacy of antiretroviral therapy (ART). However, to date, reports of HIV RNA levels in the population have been limited to urban areas in developed countries, such as Vancouver, San Francisco, and Washington, while neglecting areas like sub-Saharan Africa that have more than 23 million HIV-infected people. . In addition, the high cost of detecting HIV RNA levels is also largely limiting its widespread use. In response to the above situation, Vivek Jain, MD, from the HIV/AIDS department of the San Francisco General Hospital of the University of California, San Francisco, conducted a study published online December 12, 2012 in Clinical Infectious Diseases ( Clincal Infectious Diseases). The researchers found that HIV-based RNA detection based on fingertips can effectively detect population-based HIV RNA levels.
The study examined population-based HIV RNA levels using a fingertip-based blood sampling method in rural Uganda communities where ART was expanded. The researchers confirmed the effectiveness of HIV RNA detection techniques for fingertip blood collection based on standard blood collection methods. In a community of 6,300 people, a five-day community-wide health campaign was launched using the technology. Items tested by fingertip blood collection include: rapid HIV antibody testing, viral load, and CD4+ cell count. The researchers estimated HIV RNA levels in the population and the inability to detect RNA (ie, negative RNA detection), evaluated the predictor VL using linear regression, and mapped a map reflecting RNA levels within the geographic unit of the community.
The results of the study were as follows. During the community-wide health activities, 179 (7.8%) of the 2282 adults and 10 (0.5%) of the 1826 children were found to be HIV-positive. Of the 189 HIV-positive patients, 174 (92%) were able to obtain the same judgment based on the VL value obtained by fingertip blood collection. The log-log average of VL was 3.67 log, (95% confidence interval [CI], 3.50-3.83 log copies/mL), and the median VL was 2720 copies/mL (interquartile range, <486 -38 120 copies/mL), in addition, the arithmetic mean of VL is 64 064 copies/mL. Overall, 64 of 174 adults were unable to detect RNA (37%, [95% CI, 30%-40%]), and 24% had VL values ​​between 486-10 000 copies/mL; The 25% VL value is between 10 001 and 100 000 copies/mL; there is also a 15% VL value greater than 100 000 copies/mL. 83% of those who used ART were unable to detect VL.
Researchers have developed and applied VL detection methods for fingertip blood collection, and first reported HIV RNA levels in African populations. Evidence of the efficacy of ART at the population level was found in rural communities in Uganda where ART was expanded. However, a large number of people showed viremia and lack of ART treatment, and they were at risk of transmitting HIV. For areas where limited resources are not available for routine VL testing for HIV patients during treatment, this study may provide a potential tool for detecting the efficacy of ART-enhanced use and also contribute to further HIV-infected areas worldwide. Understand the epidemiology and propagation dynamics of HIV.