 |
|
|
| |
Almost 40% of HIV+ People in Care in US Have Detectable Viral Load
|
| |
| |
Almost 40% of HIV+ People in Care in US Have Detectable Viral Load
Conference on Retroviruses and Opportunistic Infections (CROI), February 22-25, 2016, Boston
Mark Mascolini
Nearly 40% of 238,641 HIV-positive people in care in the United States in 2012-2013 did not maintain an undetectable viral load for those 2 years [1]. Many of these people with uncontrolled HIV had sustained loads above 1500 or 10,000 copies, levels that pose a threat of HIV transmission. The glass-half-full view of these findings is that more than 60% of people in care kept their viral load below 200 copies on all measurements during those 2 years.
Undetectable viremia is the holy grail at the end of the HIV care cascade, not only because it promotes health and longevity in the treated person, but also because it virtually eliminates the risk of HIV transmission. Many studies charting rates of reaching an undetectable viral load consider a single viral load measure. Centers for Disease Control and Prevention (CDC) researchers decided to track rates of undetectability over the course of 2 years.
The analysis involved people 13 or older diagnosed with HIV before 2011 and in care in one of 17 jurisdictions that report complete CD4 and viral load data to the CDC’s National HIV Surveillance System. Everyone had at least one viral load test in 2011 and at least two in 2012-2013, and everyone was alive at the end of 2013. The CDC defined durable viral suppressive as a load below 200 copies throughout the 2-year period. They defined viremia copy-years as viral load for each time interval between two consecutive measures, calculated by multiplying the average of the two adjacent loads by the time between them.
The study group included 238,641 people, 76% of them men, 38% black, 31% white, and 25% Hispanic. By HIV transmission risk 56% were men who have sex with men (MSM) (including MSM drug injectors), 11% male or female drug injectors, 12% women infected during sex with men, and 5% men infected during sex with women. Almost 14% of the study groups had a gap in HIV care indicated by two viral loads more than 12 months apart.
The CDC calculated that 61.8% of these 238,641 people maintained durable HIV suppression throughout 2012 and 2013. The 91,120 participants (38.2%) without durable viral suppression spent an average 438 days with a viral load above 200 copies (60% of the 2 years), 316 days with a load above 1500 copies (43% of the 2 years), and 215 days with a load above 10,000 copies (29.5% of the 2 years).
Several subgroups spent a significantly longer average time with a viral load above 10,000 copies, including women versus men (221 versus 213 days), blacks and Hispanics versus whites (233 and 201 days versus 192 days), female injection drug users versus MSM (232 versus 209 days), MSM drug injectors versus other MSM (243 versus 209 days), heterosexual women versus MSM (222 versus 209 days), people with less than 1 year since HIV diagnosis to the end of 2010 (231 days) or 1 to 2 years since diagnosis to the end of 2010 (232 days) versus people with 3 or more years since diagnosis (212 days), and people with a gap in HIV care versus those with no gap (337 versus 192 days).
Compared with people 55 or older (143 days), all younger groups spent a significantly longer average time with a load above 10,000 copies: 45 to 54 (194 days), 35 to 44 (233 days), 25 to 34 (266 days), and 13 to 24 (276 days).
The long time spent with a viral load above transmission thresholds of 1500 or 10,000 copies raises concern, the CDC noted, "because they were not isolated blips of viremia, but rather extended periods of many months of elevated risk transmission potential." The researchers observed that viral burden typically proved higher in groups found to have poor engagement in care in previous research. They proposed "there is still considerable room to increase provider's delivery of brief prevention counseling to HIV patients, especially those who are not durably suppressed as recommended by treatment and care guidelines."
Reference
1. Crepaz N, Tang T, Marks G, Mugavero MJ, Espinoza L, Hall HI. Durable viral suppression among HIV-diagnosed persons United States, 2012-2013. Conference on Retroviruses and Opportunistic Infections (CROI), February 22-25, 2016, Boston. Abstract 1033.
|
| |
|
|
|
|
|
