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Only Half of Big US HIV Group Had Durable Viral Suppression in 2014
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Conference on Retroviruses and Opportunistic Infections (CROI), February 13-16, 2017, Seattle
Mark Mascolini
Across 33 US jurisdictions, three quarters of people with only one viral load measure in 2014 had viral suppression, according to a large Centers for Disease Control and Prevention (CDC) analysis of people diagnosed with HIV [1]. But only half of people with more viral load measures had durable viral suppression in 2014.
CDC researchers who conducted this study note that a viral load below 200 copies in the past 12 months is the most common measure of viral suppression, but a single value does not capture fluctuations in viral control over time. They conducted this analysis in 33 US jurisdictions to assess viral dynamics over a 12-month observation period.
Data came from the CDC's National HIV Surveillance System and included people at least 13 years old who had HIV diagnosed by the end of 2013 and were alive at the end of 2014. The researchers defined viral suppression as a load below 200 copies. Durable suppression meant (1) all viral loads in 2014 below 200 copies or (2) in people with only one 2014 viral load, the last viral load in 2013 below 200 copies.
Among 630,965 people with diagnosed HIV in 2014, 339,515 (54%) had two or more viral load tests, 92,309 (14%) had one viral load test, and 199,141 (32%) had no viral load tests. Cohort members had a median of 2 viral load tests. Among the 92,309 people with only one 2014 viral load assay, 69,960 (76%) had viral suppression, and 53,834 (77%) of that group had viral suppression on their last 2013 test.
In the entire 630,965-person group, 361,801 (57%) had viral suppression on their last 2014 test, 300,477 (48%) had durable suppression in 2014, and 51,114 (8%) never attained suppression in 2014. Proportions with durable viral suppression in 2014 were higher in males than females (49% vs 44%), higher in whites than in Hispanics or blacks (56% vs 48% vs 40%), and higher in men who have sex with men (MSM) (53%) than in heterosexual females (48%), heterosexual males (44%), female drug injectors (41%), or male drug injectors (38%). A higher proportion of people 55 or older had durable suppression (53%) than did people 45 to 54 (50%), 35 to 44 (45%), 25 to 34 (40%), or 13 to 24 (33%).
Proportions who never achieved viral suppression in 2014 were higher in women than men (10% vs 7%), higher in blacks than Hispanics or whites (11% vs 7% vs 5%), higher in female drug injectors (11%) than in heterosexual females (10%), heterosexual males (9%), male drug injectors (8%), or MSM (7%), and higher in 13- to 24-year-olds (18%) than in the 25-to-34 group (13%), the 35-to-44 group (9%), the 45-to-54 group (7%), and the 55+ group (4%).
Failure ever to achieve viral suppression in 2014 was consistently higher in blacks than in Hispanics or whites whether the group was MSM (12% vs 6% vs 4%), male drug injectors (11% vs 9% vs 7%), MSM drug injectors (14% vs 10% vs 8%), heterosexual men (12% vs 7% vs 5%), heterosexual women (12% vs 8% vs 9%), or female drug injectors (14% vs 12% vs 10%).
Among 339,515 people with 2 or more viral load assays in 2014, 75% had suppression on their first and last tests, 11% improved from first to last test, 4% worsened from first to last test, and 10% were unsuppressed on their first and last tests.
The CDC investigators underlined the "concerning" lack of any viral suppression in 8% of people diagnosed with HIV. They add that an additional 32% with no viral load test in 2014 probably did not have viral suppression. Differences in viral suppression by sex, race, and age "indicate [a] need for intensified efforts to reduce viral load and HIV transmission in the US." On the plus side, they conclude, viral suppression improved more often than worsened in this large cohort.
Reference
1. Crepaz N, Tang T, Marks G, Hall I, et al. Viral-load dynamics among persons with diagnosed HIV: United States, 2014. Conference on Retroviruses and Opportunistic Infections (CROI), February 13-16, 2017, Seattle. Abstract 31.
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