Does Viral Suppression Really Matter?
A number of studies have suggested that the short-term prognosis for patients without complete virologic suppression is no worse than for those who maintain viral loads below 50 c/mL. These results have been seized on by those who reject what they refer to as the “dogma of undetectability.” However, data from the Danish HIV Cohort Study suggest that viral suppression really does make a difference, including a difference in mortality [Lohse N, et al. Abstract H-515, and Clin Infect Dis. 2006 Jan 1;42(1):136-44]. This study looked at virologic control during the first 6-18 months of therapy as a predictor of long-term outcome. The investigators divided the cohort into 3 groups based on the proportion of their viral loads that were detectable (>400 c/mL) during the 6-18 month period after starting HAART: patients in Group 1 never had detectable viremia, those in Group 2 sometimes had detectable viremia (1-99% of the time), and those in Group 3 always had detectable viremia. This was a lar
