Comments on: Community Viral Load: A New Way to Measure our Progress

By: Romy

Romy — Tue, 24 Jul 2012 22:19:44 +0000

I love this concept of CVL. I do not live in the US. But people must understand the fact that theories are meant to explain things, make sense of the reality. They might not be perfect but they are explanatory. Let’s assume you move in a population P1 where there is no one with HIV, thus having a CVL of 0 and happen to be in intimate unprotected sexual contact with an individual there, chances of getting the virus is 0. Let’s take a second population P2 in which every one is infected and no one on treatment, the same contact will bear significantly higher risks of infection. Most of our populations are in between. By treating everyone who needs to be treated, risks of infections to partners become negligible. Of course this works on a population level, not forcibly on an individual level as each one is responsible not to transmit the virus and not to be infected.

By: Warren

Warren — Fri, 18 Mar 2011 13:03:36 +0000

I have some questions about this approach.
1) Viral load distributions are usually very skewed, aren’t they? If so, the mean isn’t an appropriate statistic. Are the vl’s first log-transformed?
2) Is there a similar index of community CD4?
3) What defines a “community”? Would all the PLWHA served by my organization constitute a community?
Any insights into these issues?
thanks – warren.

By: Jim Dickinson

Jim Dickinson — Fri, 04 Mar 2011 09:09:38 +0000

A problem that I see with this approach: it works best in places where the majority of those identified with HIV are in treatment. How does a large lost-to-care population influence this approach? How we would obtain the needed data from those in private care, if the private doc is not routinely ordering viral load testing.
And while the write-up suggests several reasons for a possible disparity among ethnic, racial and sexual orientation strata, it avoids one of the most obvious: the treatment simply isn’t working, despite access, quality care, etc. How do we account for this variable and what can we do about it?
Also, if a particular population is entering the system already AIDS defined and with extremely damaged immune function (i.e. ‘natural’ low viral load due to a lack of T-cells for HIV to replicate in) wouldn’t we need to have a mechanism for handling that data differently? Otherwise, it could give a false impression that the population is accessing care and in successful treatment when the reality is that they simply did not test until very late stage disease.
While I get the concept, it may simply be another researchers’ novelty of the week and I would have to know, of course, that it actually provides something different and useful beyond what we already do before considering investment.

By: Alexis

Alexis — Thu, 03 Mar 2011 14:29:47 +0000

Are there ways in which local ASOs and other organizations can support or help streamline public health departments in more closely monitoring community viral load? Or is it just a waiting game until PDHs get up to speed from the CDC?

By: MP

MP — Thu, 03 Mar 2011 12:56:00 +0000

“An elevated CVL can mean that persons are being diagnosed very late in the course of their infection, or that they are not receiving timely referral into medical care or even that they might require additional adherence counseling in order to maintain consistent ARV use.”
Or that they’re on an ADAP waiting list!
(over 6,000 people)
Best and most truthful comment EVER! Let’s see…most states can’t even handle getting meds to HIV positive people now and despite ‘National AIDS Strategy’ rhetoric, HIV care and prevention funding continues to drop well below the documented need. SO HOW are we supposed to be able to monitor our CVLs if we can’t even treat the individual cases?
We’re tired of talk from the administration and PACHA, we’d like to have our meds so we can stop dying. Too much to ask?

By: Marina

Marina — Wed, 02 Mar 2011 17:33:49 +0000

Is community viral load a new way to gate keep monies and redirect them to target areas of high density HIV clients demographically – case load mixing of community groups

By: Mark

Mark — Wed, 02 Mar 2011 17:17:14 +0000