 |
|
|
| |
Almost half of US women with HIV not in regular care in CDC analysis
|
| |
| |
CROI 2015, February 23-26, 2015, Seattle, Washington
Mark Mascolini
Webcast:
http://www.croiwebcasts.org/console/player/25693?mediaType=slideVideo&
Almost half of women diagnosed with HIV through 2010 in 17 US states and Washington, DC were not in regular care in 2011, according to a 100,000-woman study by the Centers for Disease Control and Prevention (CDC) [1]. Only 44% of women reached an undetectable viral load. Among 3900 women diagnosed with HIV in 2012, 83% entered care within 3 months.
CDC investigators noted that women account for one quarter of HIV infections in the United States. The new diagnosis rate is 19 times higher in black women than white women and 3.5 times higher in Hispanics than whites. Previous research found disparities in linkage to care and retention, as well as treatment outcomes, by race and ethnicity in the United States. The CDC conducted this study to assess those outcomes specifically in women with HIV.
The analysis involved adolescents or women at least 13 years old with an HIV diagnosis reported to the US National HIV Surveillance System through December 2013. These women lived in Washington, DC and 17 states across the country where laws require reporting of CD4 and viral load results. The CDC team defined linkage to care as 1 or more CD4 counts or viral load tests within 3 months of an HIV diagnosis in 2012. Among women diagnosed through 2010 and alive in 2011, the researchers defined retention in care as (1) one or more CD4 counts or viral loads in 2011 or (2) two or more CD4 counts or viral loads at least 3 months apart in 2011. Viral suppression among women diagnosed through 2010 and alive in 2011 meant a viral load below 200 copies on the most recent test during 2011.
Among 3903 women diagnosed with HIV in 2012, 83% were linked to care within 3 months. Rates did not vary between blacks, whites, Hispanics, or Asians. By age, 86% of women 45 to 54 years old and 85% of those 55 or older entered care within 3 months of diagnosis, compared with 78% of 13- to 24-year-olds and 82% of 25- to 44-year-olds. Those differences were not statistically significant.
Among 102,726 women diagnosed with HIV through 2010, only 67% were retained in care by the definition requiring 1 or more CD4 counts or viral load tests, and only 52% stayed in care by the definition requiring 2 or more CD4 counts or viral loads 3 months apart. With the 2-test definition, significantly higher proportions of Hispanics (59%) and blacks (50%) than whites (47%) stayed in care. But compared with whites, significantly lower proportions of American Indians/Alaska Natives (33%), Pacific Islanders (37%), or Asians (46%) stayed in care.
With the 2-test definition of retention in care, significantly lower proportions in every age group below 55 had lower retention in care than women 55 or older (57%). Women 25 to 34 (46%) and 35 to 44 (49%) had the lowest retention rates. Retention rates did not differ between women infected with HIV while injecting drugs and those infected during sex.
Among the 102,726 women in the retention analysis, 44% reached an undetectable viral load. Compared with whites, a significantly higher proportion of Hispanic women attained viral suppression (49% versus 47%), while significantly lower proportions of blacks (42%) and American Indians/Alaska Natives (30%) hit the viral suppression target.
Women 55 or older had the highest viral suppression rate (53%), while significantly lower proportions of women 25 to 34 (36%) and women 35 to 44 (42%) attained viral suppression. Suppression rates were nonsignificantly lower in women infected with HIV while injecting drugs (42%) than while having sex (46%).
Emphasizing the low proportion of diagnosed women not in regular care in these 18 regions, the CDC investigators noted that this finding underestimates the true proportion of HIV-positive women not in care because they studied only women with diagnosed HIV infection. They concluded that "improvements in care and treatment outcomes are needed for all females with particular emphasis on younger females and eliminating disparities in viral suppression among racial/ethnic groups."
Reference
1. Ike N, Hernandez AL, An Q, Huang T, Hall HI. Care and viral suppression among women, 18 US jurisdictions. CROI 2015. February 23-26, 2015. Seattle, Washington. Abstract 100.
|
| |
|
|
|
|
|
