HIV: viral suppression rates up, but treatment gaps remain

  • Nance RM et al
  • Ann Intern Med
  • 21 Aug 2018

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Viral suppression rates among people living with HIV (PLWH) in the United States improved ~3-fold during 1997-2015.
  • Large disparities in viral suppression continue to persist among younger or black PLWH.

Why this matters

  • Earlier initiation of antiretroviral therapy (ART, especially at HIV diagnosis) promotes viral suppression and care retention, especially among PLWH who may be receiving care in lower resource settings.
  • Evolving use of integrase strand transfer inhibitors (ISTIs) contributed to recent improved viral suppression trends.

Key results

  • 31,930 PLWH with >1 viral load (VL) measure post-1997.
  • Viral suppression increased from 32% to 86% during time frame.
  • Adjusted analyses in patients receiving ART linked black race (OR=1.68; P<.001 and increased odds of detectable vl.>
  • Using VL as a continuous outcome, black race (OR=1.60; P<.001 younger age p were associated with higher vl.>
  • Conversely, Hispanic race (OR=0.89; P<.001 isti use p with lower relative vl.>

Study design

  • Longitudinal, observational cohort study examining changes in HIV viral suppression over time (1997-2015) and association of viral suppression with changing demographic characteristics.
  • Funding: National Institutes on Alcohol Abuse and Alcoholism at NIH.

Limitations

  • Observational.
  • Self-reported adherence, sensitivity classification bias in 1997 measures.
  • Residual bias (loss to follow-up).
  • Clinical site differences.

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