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Virologic and Immunologic Monitoring in HIV Care

Lead Author: , MD; Writing Group: , MD, PhD, , MD, , MD, FACP, FIDSA, , MD, MPH, PhD, , MS, , MD, and , MD, MPH; on behalf of Medical Care Criteria Committee .

Baltimore (MD): Johns Hopkins University; .

Updates, Authorship, and Related Guidelines

Developer and funding source

New York State Department of Health AIDS Institute (NYSDOH AI)

Intended users

Clinicians providing ambulatory care for patients with HIV

Development

See Supplement: Guideline Development and Recommendation Ratings

Updates

June 16, 2022

Updated Table 1: Recommended Viral Load and CD4 Count Monitoring in Nonpregnant Patients With HIV

Author and writing group conflict of interest disclosures

See Conflict of Interest statement*

Related NYSDOH AI guidelines

Related NYSDOH AI Guidance

Purpose of This Guideline

Date of current publication: June 16, 2022 Lead author: Samuel T. Merrick, MD Writing group: Steven M. Fine, MD, PhD; Rona Vail, MD; Joseph P. McGowan, MD, FACP, FIDSA; Asa Radix, MD, MPH, PhD; Jessica Rodrigues; Christopher J. Hoffmann, MD, MPH; Charles J. Gonzalez, MD Committee: Medical Care Criteria Committee Date of original publication: June 1, 2016

Periodic laboratory tests are necessary to evaluate a patient’s response to antiretroviral therapy (ART). Monitoring HIV-1 RNA levels (viral load) to confirm appropriate response to treatment and durable viral suppression is the most accurate and meaningful measure of the effectiveness of ART [Gale, et al. 2013]. HIV suppression is essential to the health of the individual with HIV and to preventing HIV transmission through sex.

Regular immunologic monitoring in patients with consistently undetectable HIV viral loads and CD4 counts >200 cells/mm3 offers little utility in clinical practice today. Clinicians rarely use this information to guide decision-making for clinically stable, virologically suppressed patients.

The New York State Department of Health AIDS Institute has developed these evidence-based recommendations for ambulatory care of patients with HIV to accomplish the following:

  • Guide clinicians in the use of HIV viral load testing at appropriate times and intervals to assess initial and ongoing ART responses.
  • Clarify the appropriate use of immunologic (CD4 count) monitoring in the care of patients with HIV.

Note on “experienced” and “expert” HIV care providers: Throughout this guideline, when reference is made to “experienced HIV care provider” or “expert HIV care provider,” those terms are referring to the following 2017 NYSDOH AI definitions:

  • Experienced HIV care provider: Practitioners who have been accorded HIV Experienced Provider status by the American Academy of HIV Medicine or have met the HIV Medicine Association’s definition of an experienced provider are eligible for designation as an HIV Experienced Provider in New York State. Nurse practitioners and licensed midwives who provide clinical care to individuals with HIV in collaboration with a physician may be considered HIV Experienced Providers as long as all other practice agreements are met (8 NYCRR 79-5:1; 10 NYCRR 85.36; 8 NYCRR 139-6900). Physician assistants who provide clinical care to individuals with HIV under the supervision of an HIV Specialist physician may also be considered HIV Experienced Providers (10 NYCRR 94.2)
  • Expert HIV care provider: A provider with extensive experience in the management of complex patients with HIV.

Viral Load and CD4 Count Monitoring Intervals

RECOMMENDATIONS

Monitoring Intervals

  • To assess a patient’s response to antiretroviral therapy (ART) and immunologic status and to identify when a change in ART regimen is needed, clinicians should perform plasma HIV-1 RNA level (viral load) and CD4 count testing as detailed in Table 1: Recommended Viral Load and CD4 Count Monitoring in Nonpregnant Patients With HIV. (A1)
  • Clinicians should address modifiable barriers to adherence and engagement in care to help ensure optimal virologic suppression. Modifiable barriers may include, but are not limited to, substance use, mental illness, other chronic medical conditions, ART-associated adverse medication effects, unstable housing, or low health literacy. (A2)
  • Quarterly CD4 count monitoring is no longer recommended for nonpregnant patients receiving ART who have consistently undetectable viral load levels and CD4 counts >200 cells/mm3 (see Table 1 for recommended intervals). (A2)

Very few studies address the appropriate frequency of viral load monitoring. A retrospective study noted that the strongest predictor of virologic failure at 12 months was a missed or canceled appointment rather than the interval of follow-up [Buscher, et al. 2013]. However, this and other similar studies [Romih, et al. 2010; Reekie, et al. 2008] have significant limitations, including their retrospective nature and short follow-up periods. Data indicate that the linked sexual transmission of HIV in serodiscordant couples in which the partner with HIV maintains sustained viral suppression is negligible [Rodger, et al. 2016].

Based on this information, those with HIV may rely on ART as a strategy to prevent viral transmission to an uninfected partner. Studies do not indicate the appropriate interval for viral suppression monitoring for ongoing transmission prevention. Until more definitive data are available, the decision to lengthen monitoring intervals for HIV RNA levels should be individualized. Patients who are monitored at longer intervals should be carefully selected based on length of viral suppression, CD4 count, use of ART for transmission prevention, and adherence to medical care, including visit attendance and retention in care.

Key Point
  • Quarterly HIV RNA monitoring remains appropriate for patients with a recent history of nonadherence, mental health disorders, substance use, homelessness, poor social support system, or other major medical conditions. Semiannual monitoring may be appropriate for patients with persistently undetectable HIV RNA and none of the above characteristics.

Table 1, below, provides a guide for monitoring HIV RNA levels and CD4 counts.

Table 1: Recommended Viral Load and CD4 Count Monitoring in Nonpregnant Patients With HIV [a]
Event HIV RNA Viral Load CD4 Count Comments
Entry into careBaseline viral load (A1)Baseline CD4 count (A1)
  • If a patient is not taking ART, recommend initiation [b] (A1)
  • Monitor as below
Patients Taking ART
ART initiation or change to address virologic failure
  • Within 4 weeks after ART start or change (A3)
  • At least every 8 weeks until complete virologic suppression is documented (A3)
  • 12 weeks after ART initiation
  • Every 4 months until CD4 count >200 cells/mm3 is obtained on 2 measurements at least 4 months apart (A2), then monitor as below once virologic suppression is achieved
  • Virologic failure occurs when a viral load <200 copies/mL is either not achieved or not maintained
  • Virologic suppression is defined as a viral load <20 to <50 copies/mL obtained with a highly sensitive assay
ART change for simplification or due to adverse effectsWithin 4 weeks after ART change, then as below (A3)Monitor as below for documented virologic suppression—
Documented viral suppression
  • At least every 4 months (A3)
  • May extend interval to 6 months in patients stable on ART with CD4 count >200 cells/mm3 and complete viral suppression for 1 year (B2)
  • At least every 6 months if CD4 count is ≤350 cells/mm3 (B2)
  • Optional if CD4 count is >350 cells/mm3 (B2)
—
New HIV RNA ≥500 copies/mL after previous viral suppressionRepeat viral load test 2 weeks after first result (A2)Obtain CD4 count if previous result is >6 months old (B3)
New HIV RNA level over the limit of detection of sensitive assays, 20 to 50 copies/mL, but <500 copies/mL after previous viral suppressionRepeat viral load test within 4 weeks to differentiate low-level transient viremia (“blip”) from virologic failure [c] (A2)If repeat viral load is detectable, obtain CD4 count if previous result is >6 months old (B3)
  • Assess for adherence and drug-drug interactions (A3)
  • If repeat viral load is detectable, consider resistance testing [d] (B3)
  • Patients with low-level viremia ≤200 copies/mL over a period of 12 months without demonstrated failure may continue routine testing intervals of at least every 4 months [e]
Patients Not Taking ART
CD4 count ≤500 cells/mm3 (A2)At least every 4 monthsAt least every 4 monthsAt every visit, recommend ART initiation [b]
CD4 count >500 cells/mm3 (A2)At least every 6 monthsAt least every 6 monthsAt every visit, recommend ART initiation [b]

Abbreviation: ART, antiretroviral therapy.

Notes:

a
b

See NYSDOH AI guideline Rapid ART Initiation.

c

An ART regimen should not be changed based on a single viral load elevation. The risk of virologic rebound (breakthrough) increases when values are ≥500 copies/mL [Grennan, et al. 2012].

d

Standard genotypic tests may not provide resistance results when viral load is low. For repeated low-level viremia, an assay that detects resistance mutations in archived proviral DNA is available; however, clinical data are insufficient to recommend for or against its use in the patient care setting.

e

In patients with low-level viremia, clinicians should consult with an experienced HIV care provider; low-level viremia can be due to multiple causes, and its clinical effect is not clear.

Virologic Monitoring (HIV Viral Load)

Plasma HIV-1 RNA level (viral load): Plasma levels of viral RNA have been shown to correlate with clinical outcomes, including overall mortality, and measurement of HIV RNA levels provides the most precise means of establishing whether a response to antiretroviral therapy (ART) has occurred [HIV Surrogate Marker Collaborative Group 2000; Thiebaut, et al. 2000; Murray, et al. 1999; Marschner, et al. 1998; Mellors, et al. 1997].

HIV RNA levels should be obtained from all patients at baseline [Porter, et al. 2015; Behrens, et al. 2014; Molina, et al. 2013; Tarwater, et al. 2004; Gulick, et al. 2003; Wu, et al. 2003].

For patients beginning ART, or those changing therapy as a result of virologic failure, HIV RNA should be measured at 4 weeks after initiation of ART and should decrease by at least 1 log (10-fold) in the presence of effective therapy [Haubrich, et al. 2011] (see Table 2, below). For patients who do not have background antiretroviral resistance, an undetectable viral load (<50 copies/mL) is usually achieved within 3 months. Patients with a baseline HIV viral load >100,000 copies/mL can be expected to achieve an undetectable viral load within 6 months of effective treatment.

Table 2. Interpretation of Viral Load.

Table 2

Interpretation of Viral Load. Abbreviation: ART, antiretroviral therapy.

An absent or incomplete response of viral load to ART should raise concerns about poor adherence to therapy and/or viral resistance [Townsend, et al. 2009; Baxter, et al. 2000].

Blips: Patients on previously suppressive ART with newly detectable HIV RNA levels of 50 to 500 copies/mL may be experiencing low-level transient viremia (“blip”) and not virologic failure. A blip by definition means that the viral load is again below the level of quantification on repeat testing performed promptly after a detectable result in someone previously suppressed. Persistent elevation, even at low levels, warrants further investigation. Acute concurrent illness and/or recent vaccination may cause this transient rise; however, studies have suggested that low-level transient viremia represents random biologic and statistical variation or false elevations of viral load resulting from laboratory processing [Lee, et al. 2006; Nettles, et al. 2005]. Blips are not known to be associated with the development of resistance mutations or virologic failure and do not require a change in ART [Lee, et al. 2006]. Retesting should be performed within 4 weeks to differentiate low-level transient viremia (a blip) from sustained viremia and possible virologic failure. The risk of virologic rebound (breakthrough) increases when values are >500 copies/mL [Grennan, et al. 2012]. However, ART should not be changed based on a single viral load elevation.

Advances in molecular detection technology have led to the development of HIV nucleic acid tests that are highly sensitive and more reliable than earlier versions. Real-time polymerase chain reaction (PCR) technology has been widely adopted for HIV-1 RNA quantification, but new technologies are continually emerging and being adapted to viral detection and quantification. The currently available HIV-1 viral load tests that use real-time PCR technology offer a larger dynamic range of quantification than early-version viral load tests. The lower and upper limits of quantification of the currently available U.S. Food and Drug Administration (FDA)-approved HIV-1 viral load tests are shown in Table 3, below. Several different HIV viral load tests have been developed, and 4 are currently approved for use in the United States.

Table 3: FDA-Approved Quantitative HIV-1 RNA Assays for Viral Load Monitoring
Test Name Method Lower and Upper LOQ
Abbott RealTime HIV-1 (Abbott Laboratories)Real-time PCR
  • 40 copies/mL [a]
  • 10,000,000 copies/mL
Cobas AmpliPrep/Cobas TaqMan HIV-1 Test, version 2.0 (Roche Diagnostics)Real-time PCR
  • 20 copies/mL
  • 10,000,000 copies/mL
Cobas HIV-1 quantitative NAT for use on Cobas 6800/8800 systems (Roche Diagnostics)Real-time PCR
  • 20 copies/mL
  • 10,000,000 copies/mL
Cobas TaqMan HIV-1 Test, v2.0 for use with the high pure system (Roche Diagnostics)Real-time PCR
  • 34 copies/mL
  • 10,000,000 copies/mL

Abbreviations: FDA, U.S. Food and Drug Administration; LOQ, limit of quantification; NAT, nucleic acid test; PCR, polymerase chain reaction.

Note:

a

This lower LOQ applies when 1.0 mL of plasma is used. When 0.5 and 0.2 mL of plasma are used, the lower LOQ is 75 copies/mL and 150 copies/mL, respectively.

All of the current FDA-approved viral load assays quantify the level of cell-free virus in an individual’s plasma and are approved for monitoring response to ART, tracking viral suppression, and detecting treatment failure. Successful ART should decrease the viral load by 1.5 to 2 logs (30- to 100-fold) within 6 weeks, with the viral load decreasing below the limit of detection within 6 months [DHHS 2022]. Cohort studies strongly suggest that patients with viral loads <50 copies/mL have more sustained viral suppression than patients with viral loads between 50 and 400 copies/mL. Assays that can detect <50 copies/mL are recommended for determining prolonged viral suppression and for monitoring patients who are on ART.

Key Point
  • Achieving and maintaining an undetectable viral load is always the goal of ART.

Immunologic Monitoring (CD4 Count)

Lymphocyte subsets (CD4 count): CD4 lymphocyte count is used to evaluate immunologic staging, predict the risk of clinical progression, and make decisions regarding opportunistic infection prophylaxis [Lopez Bernaldo de Quiros, et al. 2001; El-Sadr, et al. 2000]. Low CD4 counts can be seen in other disease processes and should therefore not be used to diagnose HIV infection. Although CD4 count was used historically to establish a threshold for initiating ART, current guidelines in New York State recommend ART for all patients with HIV regardless of CD4 count. For patients who may not be ready to initiate ART, CD4 count can be used to guide discussions between patient and care provider regarding the urgency of initiating ART.

Although a CD4 count should be obtained at baseline [Moore and Keruly 2007; Oldfield, et al. 1998; Havlir, et al. 1996; Schneider, et al. 1992; Fischl, et al. 1988], clinicians are unlikely to use it to guide clinical decision-making in practice for virologically suppressed patients once their CD4 count remains above 200 cells/mm3. However, for those infected with HIV-2 or HIV-1 variants that cannot be accurately quantified using viral load assays, CD4 count remains the most effective tool for monitoring disease progression.

Although a significant CD4 count increase often occurs among patients treated with effective ART, the absence of such an increase should not be interpreted as treatment failure if the viral load declines appropriately. ART regimens are generally not changed in patients with undetectable viral loads who experience immunologic failure, although patients should remain on appropriate prophylaxis for opportunistic infections based on CD4 count. One study of a cohort of more than 62,000 individuals in New York City over 1.9 years of observation reported that in those who entered the cohort with a CD4 count ≥350 cells/mm3, there was a >90% likelihood of sustaining a CD4 count >200 cells/mm3 during that period of time [Myers, et al. 2016]. Reassuringly, other data suggest that in patients with sustained viral suppression and CD4 counts between 100 and 200 cells/mm3, the risk of pneumocystis pneumonia is very low even in the absence of prophylaxis [Chaiwarith, et al. 2013; Mocroft, et al. 2010; D'Egidio, et al. 2007].

Lack of correlation between viral load and CD4 count response is particularly common among patients ≥50 years old [Sabin, et al. 2008; Gras, et al. 2007] and patients with low initial CD4 counts (<100 cells/mm3) [Kelley, et al. 2009; Moore and Keruly 2007; Garcia, et al. 2004].

Absolute CD4 counts are calculated values that may fluctuate widely. The calculation is made by multiplying the total white blood cell count (in thousands) by the percentage of total lymphocytes and then by the percentage of CD4 lymphocytes. Therefore, any change in one of these three parameters will cause the absolute CD4 count to vary. CD4 percentage is a direct measurement and more reliable than the calculated absolute CD4 value, especially over time. A stable CD4 percentage, even when fluctuations occur in the absolute CD4 count, can reassure both the patient and the clinician that immunologic stability is present.

Some factors that can cause these fluctuations include sex, age, race, drugs (zidovudine, cephalosporins, cancer chemotherapy, nicotine, interferon, and corticosteroids), anti-lymphocyte antibodies, and splenectomy. Differences in reagents and equipment both within a laboratory and between laboratories may further contribute to variations in CD4 counts. There is also interlaboratory variation of normal range.

All Recommendations

RECOMMENDATIONS

Monitoring Intervals

  • To assess a patient’s response to antiretroviral therapy (ART) and immunologic status and to identify when a change in ART regimen is needed, clinicians should perform plasma HIV-1 RNA level (viral load) and CD4 count testing as detailed in Table 1: Recommended Viral Load and CD4 Count Monitoring in Nonpregnant Patients With HIV. (A1)
  • Clinicians should address modifiable barriers to adherence and engagement in care to help ensure optimal virologic suppression. Modifiable barriers may include, but are not limited to, substance use, mental illness, other chronic medical conditions, ART-associated adverse medication effects, unstable housing, or low health literacy. (A2)
  • Quarterly CD4 count monitoring is no longer recommended for nonpregnant patients receiving ART who have consistently undetectable viral load levels and CD4 counts >200 cells/mm3 (see Table 1 for recommended intervals). (A2)

References

  • Baxter J. D., Mayers D. L., Wentworth D. N., et al. A randomized study of antiretroviral management based on plasma genotypic antiretroviral resistance testing in patients failing therapy. CPCRA 046 Study Team for the Terry Beirn Community Programs for Clinical Research on AIDS. AIDS. 2000;14(9):F83–F93. [PubMed: 10894268]
  • Behrens G., Rijnders B., Nelson M., et al. Rilpivirine versus efavirenz with emtricitabine/tenofovir disoproxil fumarate in treatment-naive HIV-1-infected patients with HIV-1 RNA </=100,000 copies/mL: week 96 pooled ECHO/THRIVE subanalysis. AIDS Patient Care STDS. 2014;28(4):168–175. [PMC free article: PMC3985528] [PubMed: 24660840]
  • Buscher A., Mugavero M., Westfall A. O., et al. The association of clinical follow-up intervals in HIV-infected persons with viral suppression on subsequent viral suppression. AIDS Patient Care STDS. 2013;27(8):459–466. [PMC free article: PMC3739946] [PubMed: 23886048]
  • Chaiwarith R., Praparattanapan J., Nuntachit N., et al. Discontinuation of primary and secondary prophylaxis for opportunistic infections in HIV-infected patients who had CD4+ cell count <200 cells/mm(3) but undetectable plasma HIV-1 RNA: an open-label randomized controlled trial. AIDS Patient Care STDS. 2013;27(2):71–76. [PubMed: 23373662]
  • D'Egidio G. E., Kravcik S., Cooper C. L., et al. Pneumocystis jiroveci pneumonia prophylaxis is not required with a CD4+ T-cell count < 200 cells/microl when viral replication is suppressed. AIDS. 2007;21(13):1711–1715. [PubMed: 17690568]
  • DHHS. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. 2022. https:​//clinicalinfo​.hiv.gov/en/guidelines​/hiv-clinical-guidelines-adult-and-adolescent-arv​/whats-new-guidelines [accessed 2019 Sep 24]
  • El-Sadr W. M., Burman W. J., Grant L. B., et al. Discontinuation of prophylaxis against Mycobacterium avium complex disease in HIV-infected patients who have a response to antiretroviral therapy. Terry Beirn Community Programs for Clinical Research on AIDS. N Engl J Med. 2000;342(15):1085–1092. [PubMed: 10766581]
  • Fischl M. A., Dickinson G. M., La Voie L. Safety and efficacy of sulfamethoxazole and trimethoprim chemoprophylaxis for Pneumocystis carinii pneumonia in AIDS. JAMA. 1988;259(8):1185–1189. [PubMed: 3257532]
  • Gale H. B., Gitterman S. R., Hoffman H. J., et al. Is frequent CD4+ T-lymphocyte count monitoring necessary for persons with counts >=300 cells/muL and HIV-1 suppression?. Clin Infect Dis. 2013;56(9):1340–1343. [PMC free article: PMC3693489] [PubMed: 23315315]
  • Garcia F., de Lazzari E., Plana M., et al. Long-term CD4+ T-cell response to highly active antiretroviral therapy according to baseline CD4+ T-cell count. J Acquir Immune Defic Syndr. 2004;36(2):702–713. [PubMed: 15167289]
  • Gras L., Kesselring A. M., Griffin J. T., et al. CD4 cell counts of 800 cells/mm. J Acquir Immune Defic Syndr. 2007;45(2):183–192. [PubMed: 17414934]
  • Grennan J. T., Loutfy M. R., Su D., et al. Magnitude of virologic blips is associated with a higher risk for virologic rebound in HIV-infected individuals: a recurrent events analysis. J Infect Dis. 2012;205(8):1230–1238. [PMC free article: PMC3308904] [PubMed: 22438396]
  • Gulick R. M., Meibohm A., Havlir D., et al. Six-year follow-up of HIV-1-infected adults in a clinical trial of antiretroviral therapy with indinavir, zidovudine, and lamivudine. AIDS. 2003;17(16):2345–2349. [PubMed: 14571186]
  • Haubrich R. H., Riddler S. A., Ribaudo H., et al. Initial viral decay to assess the relative antiretroviral potency of protease inhibitor-sparing, nonnucleoside reverse transcriptase inhibitor-sparing, and nucleoside reverse transcriptase inhibitor-sparing regimens for first-line therapy of HIV infection. AIDS. 2011;25(18):2269–2278. [PMC free article: PMC3572727] [PubMed: 21941167]
  • Havlir D. V., Dube M. P., Sattler F. R., et al. Prophylaxis against disseminated Mycobacterium avium complex with weekly azithromycin, daily rifabutin, or both. California Collaborative Treatment Group. N Engl J Med. 1996;335(6):392–398. [PubMed: 8676932]
  • HIV Surrogate Marker Collaborative Group Human immunodeficiency virus type 1 RNA level and CD4 count as prognostic markers and surrogate end points: a meta-analysis. HIV Surrogate Marker Collaborative Group. AIDS Res Hum Retroviruses. 2000;16(12):1123–1133. [PubMed: 10954887]
  • Kelley C. F., Kitchen C. M., Hunt P. W., et al. Incomplete peripheral CD4+ cell count restoration in HIV-infected patients receiving long-term antiretroviral treatment. Clin Infect Dis. 2009;48(6):787–794. [PMC free article: PMC2720023] [PubMed: 19193107]
  • Lee P. K., Kieffer T. L., Siliciano R. F., et al. HIV-1 viral load blips are of limited clinical significance. J Antimicrob Chemother. 2006;57(5):803–805. [PubMed: 16533823]
  • Lopez Bernaldo de Quiros J. C., Miro J. M., Pena J. M., et al. A randomized trial of the discontinuation of primary and secondary prophylaxis against Pneumocystis carinii pneumonia after highly active antiretroviral therapy in patients with HIV infection. Grupo de Estudio del SIDA 04/98. N Engl J Med. 2001;344(3):159–167. [PubMed: 11172138]
  • Marschner I. C., Collier A. C., Coombs R. W., et al. Use of changes in plasma levels of human immunodeficiency virus type 1 RNA to assess the clinical benefit of antiretroviral therapy. J Infect Dis. 1998;177(1):40–47. [PubMed: 9419168]
  • Mellors J. W., Munoz A., Giorgi J. V., et al. Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1 infection. Ann Intern Med. 1997;126(12):946–954. [PubMed: 9182471]
  • Mocroft A., Reiss P., Kirk O., et al. Is it safe to discontinue primary Pneumocystis jiroveci pneumonia prophylaxis in patients with virologically suppressed HIV infection and a CD4 cell count <200 cells/microL?. Clin Infect Dis. 2010;51(5):611–619. [PubMed: 20645862]
  • Molina J. M., Clumeck N., Redant K., et al. Rilpivirine vs. efavirenz in HIV-1 patients with baseline viral load 100,000 copies/ml or less: week 48 phase III analysis. AIDS. 2013;27(6):889–897. [PubMed: 23276806]
  • Moore R. D., Keruly J. C. CD4+ cell count 6 years after commencement of highly active antiretroviral therapy in persons with sustained virologic suppression. Clin Infect Dis. 2007;44(3):441–446. [PubMed: 17205456]
  • Murray J. S., Elashoff M. R., Iacono-Connors L. C., et al. The use of plasma HIV RNA as a study endpoint in efficacy trials of antiretroviral drugs. AIDS. 1999;13(7):797–804. [PubMed: 10357378]
  • Myers J. E., Xia Q., Torian L. V., et al. Implementation and operational research: CD4 count monitoring frequency and risk of CD4 count dropping below 200 cells per cubic millimeter among stable HIV-infected patients in New York City, 2007-2013. J Acquir Immune Defic Syndr. 2016;71(3):e73–e78. [PMC free article: PMC4770377] [PubMed: 26536317]
  • Nettles R. E., Kieffer T. L., Kwon P., et al. Intermittent HIV-1 viremia (blips) and drug resistance in patients receiving HAART. JAMA. 2005;293(7):817–829. [PubMed: 15713771]
  • Oldfield E. C., Fessel W. J., Dunne M. W., et al. Once weekly azithromycin therapy for prevention of Mycobacterium avium complex infection in patients with AIDS: a randomized, double-blind, placebo-controlled multicenter trial. Clin Infect Dis. 1998;26(3):611–619. [PubMed: 9524832]
  • Porter D. P., Kulkarni R., Fralich T., et al. 96-week resistance analyses of the STaR study: rilpivirine/emtricitabine/tenofovir DF versus efavirenz/emtricitabine/tenofovir DF in antiretroviral-naive, HIV-1-infected subjects. HIV Clin Trials. 2015;16(1):30–38. [PubMed: 25777187]
  • Reekie J., Mocroft A., Sambatakou H., et al. Does less frequent routine monitoring of patients on a stable, fully suppressed cART regimen lead to an increased risk of treatment failure?. AIDS. 2008;22(17):2381–2390. [PubMed: 18981778]
  • Rodger A. J., Cambiano V., Bruun T., et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316(2):171–181. [PubMed: 27404185]
  • Romih V., Zidovec Lepej S., Gedike K., et al. Frequency of HIV-1 viral load monitoring of patients initially successfully treated with combination antiretroviral therapy. PLoS One. 2010;5(11):e15051. [PMC free article: PMC2991345] [PubMed: 21124844]
  • Sabin C. A., Smith C. J., d'Arminio Monforte A., et al. Response to combination antiretroviral therapy: variation by age. AIDS. 2008;22(12):1463–1473. [PubMed: 18614870]
  • Schneider M. M., Hoepelman A. I., Eeftinck Schattenkerk J. K., et al. A controlled trial of aerosolized pentamidine or trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection. The Dutch AIDS Treatment Group. N Engl J Med. 1992;327(26):1836–1841. [PubMed: 1360145]
  • Tarwater P. M., Gallant J. E., Mellors J. W., et al. Prognostic value of plasma HIV RNA among highly active antiretroviral therapy users. AIDS. 2004;18(18):2419–2423. [PubMed: 15622318]
  • Thiebaut R., Morlat P., Jacqmin-Gadda H., et al. Clinical progression of HIV-1 infection according to the viral response during the first year of antiretroviral treatment. Groupe d'Epidemiologie du SIDA en Aquitaine (GECSA). AIDS. 2000;14(8):971–978. [PubMed: 10853978]
  • Townsend D., Troya J., Maida I., et al. First HAART in HIV-infected patients with high viral load: value of HIV RNA levels at 12 weeks to predict virologic outcome. J Int Assoc Physicians AIDS Care (Chic). 2009;8(5):314–317. [PubMed: 19759257]
  • Wu H., Mellors J., Ruan P., et al. Viral dynamics and their relations to baseline factors and longer term virologic responses in treatment-naive HIV-1-infected patients receiving abacavir in combination with HIV-1 protease inhibitors. J Acquir Immune Defic Syndr. 2003;33(5):557–563. [PubMed: 12902798]

Footnotes

Conflict of Interest: Joseph P. McGowan: Institutional Pharma grant recipient/support, clinical trial; Gilead

Created: June 2016; Last Update: June 2022.

Copyright © Johns Hopkins University Clinical Guidelines Program 2000-2024. The Clinical Guidelines Program, a collaborative effort of the NYSDOH AI and the Johns Hopkins University School of Medicine, Division of Infectious Diseases, encourages the use, reproduction, and distribution of original documents and related graphics from this program website accompanied by a full citation of source that includes: Author(s). Committee. Title. Date of publication. Full URL. Date accessed. Links to pages on this Clinical Guidelines Program website are also encouraged and may be created without seeking permission. Requests to adapt material, i.e., to change or alter in any way material from this website for inclusion in another publication, should be sent to aiguidelines@jhmi.edu. Please include detailed information about the intended use and desired adaptations.

This book is licensed under the terms of the Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY-NC-ND 3.0).

Bookshelf ID: NBK558500PMID: 32598108

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