2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE

Laboratory Tests to Monitor HIV Infection: HIV RNA Level and CD4 Lymphocyte Count

Source: CDC/Public Health Image Library

Slide40of 50FromSC Johnson, MD atNewOrleans, LA, December 4-7, 2019, Ryan WhiteHIV/AIDS ProgramCLINICAL CONFERENCE, IAS  USA.

Virologic Response Definitions

• Virologic Suppression: A confirmed HIV RNA level below the lower limit of detection of available assays. • Virologic Failure: The inability to achieve or maintain suppression of viral replication to an HIV RNA level <200 copies/mL. • Incomplete Virologic Response: Two consecutive plasma HIV RNA levels ≥200 copies/mL after 24 weeks on an ARV regimen in a patient who has not yet had documented virologic suppression on this regimen. • Virologic Rebound: Confirmed HIV RNA level ≥200 copies/mL after virologic suppression.

Slide41of 50FromSC Johnson, MD atNewOrleans, LA, December 4-7, 2019, Ryan WhiteHIV/AIDS ProgramCLINICAL CONFERENCE, IAS  USA.

Virologic Response Definitions

• Virologic Blip: After virologic suppression, an isolated detectable HIV RNA level that is followed by a return to virologic suppression. • Low-Level Viremia: Confirmed detectable HIV RNA level <200 copies/mL • Potential causes of blips and low-level viremia: ▫ Intermittent adherence ▫ Laboratory error ▫ Release of virus from latent reservoirs ▫ Early virologic failure

Slide42of 50FromSC Johnson, MD atNewOrleans, LA, December 4-7, 2019, Ryan WhiteHIV/AIDS ProgramCLINICAL CONFERENCE, IAS  USA.