Assessment of Population-Based HIV RNA Levels in a Rural East African Setting Using a Fingerprick-Based Blood Collection Method
Assessment of Population-Based HIV RNA Levels in a Rural East African Setting Using a Fingerprick-Based Blood Collection Method
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DOI：
10.1093/cid/cis881
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发表时间：
2013-02-15
影响因子：
11.8
通讯作者：
Havlir, Diane V.
中科院分区：
文献类型：
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作者：
Jain, Vivek;Liegler, Teri;Havlir, Diane V.
背景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]）是抗逆转录病毒治疗（ART）项目有效性的建议指标。我们估计人口为基础的艾滋病毒RNA水平使用手指针刺为基础的方法在乌干达农村社区实施快速ART规模扩大。一个手指针刺为基础的HIV RNA测量技术进行了验证，对标准放血。这项技术是在一个为期5天的社区范围内的健康活动，在6300人的社区部署。评估包括快速HIV抗体检测、VL和通过手指针刺进行的CD 4 + T细胞计数。我们估计了人群HIV RNA水平和检测不到的RNA的流行率，通过线性回归评估了VL的预测因子，并绘制了社区地理单元内的RNA水平。在全社区的卫生运动期间，2 282名成人中有179名（7.8%）和1 826名儿童中有10名（0.5%）艾滋病毒血清检测呈阳性。在189名HIV阳性者中有174名（92%）确定了手指针刺VL。平均对数（VL）为3.67 log（95%置信区间[CI]，3.50-3.83 log拷贝/mL），中位VL为2720拷贝/mL（四分位距，100 000拷贝/mL）。在接受ART的参与者中，83%的人检测不到VL。我们开发并实施了一种手指针刺VL检测方法，并提供了非洲人群HIV RNA水平的第一份报告。在乌干达一个正在扩大抗逆转录病毒治疗规模的农村社区，我们发现了人群水平抗逆转录病毒治疗有效性的证据，但发现大量人群存在病毒血症，需要抗逆转录病毒治疗，并存在传播风险。
Background. 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.Methods. 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.Results. 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, 100 000 copies/mL. Among participants taking ART, 83% had undetectable VL.Conclusions. 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.