I am engaged in a research project where we have defined "durable viral load suppression" as two consecutive tests with undetectable viral load. In researching this now, though, I'm seeing studies with other definitions (such as undetectable for a full year, more undetectable than detectable, among others) as there does not appear to be one clear definition of what "durable" viral load suppression is.
Does anyone have any suggestions on which one is the "best" definition?
It depends on the duration between your two consecutive tests, for example if it is only 2 months, then that would not be considered as remarkable as 6 months or longer.
Rather than saying 2 consecutive tests, I would go for the time duration of complete suppression and consider anything longer than 6 months to be durable. This is based on the observations that viral rebound occurs within 4 - 8 weeks ( or even less) following HAART interruption ( variations depend on whether HAART was initiated during AHI or CHI). Steinggrover et al., 2008. AIDS, vol 22: pp1583-8.
I believe that durable undetectable HIV viral load is considered when at least two determinations at intervals of six months, viral load is still undetectable.
Howard, it depends on the topic you are addressing and the circumstances you are working in.
If you are studying something like the time until undetectable viral load in ART-naive, you may have a total observation time of a year and you could call patients achieveing undetectable VL without becoming detectable again during the study observation time as durably suppressed.
Generally, a life-long therapy like ART may not be considered as durable effective for a time of some months only, for the majority of the people. There are lots if infected individuals receiving one regimen for a half decade still working and even longer. Even more important, today first line ART achieves undetectable viral load in approx. 80% of treted individuals for 2 years. If this is normality, being 6 months undetectable may not looking really impressive.
If your study is done in places without extensive access to therapy monitoring, higher ART failure rates will be observed, and achievable rates of undetectable viral load can be interesting to report.
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