HIV viral load: a concept analysis and critique

Virality, desire and health assemblages: mapping (dis)continuities in the response to and management of HIV and COVID-19

In this paper, we explore the relationship between "viral load" as a virological, immunological, epidemiological and social category and how it links the four decades-long global HIV pandemic to the ongoing response to COVID-19. We argue, metaphorically, that the response to SARS-CoV-2 contains 'genetic' material from HIV, which has (as a result of the digital age which reproduces error-filled data at incredible speed) mutated and is being transmitted into the social and political body. Using sexual health and substance use as focal points, we turn to Deleuzoguattarian theoretical insights about the assemblage of desire, affect and material factors that produce epidemics. Contrasting historical and contemporary scenes and issues, we explore the complex assemblage created by viral loads, medical and public health protocols, conceptions of risk, responsibility and fear that connect both pandemics. Finally, we consider the goal of viral eradication and related militaristic metaphors, alongside the increasing convergence of medicine, public health, the law and corporate interests, and contrast this with community responses that engage with what it means to be living and dying in viral times.

Unsuppressed Viral Load Level in Public Health Facilities: Nonvirological Predictors among Adult Antiretroviral Therapy Users in Southwestern Ethiopia

BACKGROUND

Unsuppressed viral load in patients on antiretroviral (ARV) therapy occurs when treatment fails to suppress a patient's viral load, and is associated with decreased survival and increased HIV transmission. Identifying the level of unsuppressed viral load with its associated factors has benefits in controlling transmission and reducing burden. Therefore, this study aimed to assess unsuppressed viral load (>1,000 copies/mL) and associated factors among HIV patients taking first-line antiretroviral treatment at public health facilities in Jimma, Ethiopia.

METHODS

A facility-based cross-sectional study was conducted on 669 patients on first-line ARV therapy (at least 6 months) in public health facilities in Jimma. Sociodemographic, treatment, clinical, immunological, and viral load data were extracted from medical records, entered into EpiData 3.1, and analyzed with SPSS 20. Multivariate logistic regression analysis was performed to identify factors independently associated with viral nonsuppression, considering a 95% CI with P<0.05 statistically significant.

RESULTS

Among the participants, 258 (38.6%) were aged 25-34 years. Median age was 35 years. Prevalence of unsuppressed viral load was 20.3%. Risk of unsuppressed viral loads was 91% lower among ARV therapy patients who had been taking ARV therapy <2 years (AOR 0.09, 95% CI 0.01-0.83), lower baseline BMI (AOR 4.44, 95% CI 1.56-12.64), lower baseline CD4 (AOR 2.76, 95% CI 1.45-5.29), poor adherence to ARV therapy medication (AOR 3.19, 95% CI 1.29-7.89), and immunological failure (AOR 4.26, 95% CI 2.56-7.09) were the independent predictors of unsuppressed viral load.

CONCLUSION

This study revealed that there is a high level of virological failure among adult HIV patients, and confirms the need to develop close follow-up strategies of targeted interventions for patients in care who are at high risk of unsuppressed viral load.

HIV Treatment as Prevention: Implications for Health Promotion

Evidence has been accumulating in recent years that individuals with HIV who are effectively treated with antiretroviral drugs are highly unlikely to transmit the virus to their sexual partners. This approach has great potential to contribute to ongoing prevention efforts and has been termed 'treatment as prevention'. International political momentum has been building in recent years to attempt to significantly reduce new HIV infections globally and end the epidemic by 2030. In pursuit of such aims a number of local health authorities and communities have adopted intensified 'test and treat' strategies to quickly diagnose infections and reduce the risk of onward transmission through an immediate offer of treatment. These have most commonly been driven through enhancements to clinical services and health promoters have been engaged in limited ways. People with HIV often have high rates of health literacy and are now expressing interest in knowing more about how treatment as prevention might work to reduce their individual risk of sexual transmission. For some this represents an added risk reduction measure and for others it may replace condoms. There is currently an opportunity for health promotors to engage with this approach both to exploit its prevention benefits and to counter the stigma that attaches to HIV infectiousness. It is hoped that any reduction in stigma and fear of transmission will help improve the quality of social and sexual relationships among affected groups.