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Ann Intern Med. 2018 Sep 18;169(6):376-384. doi: 10.7326/M17-2242. Epub 2018 Aug 21.

HIV Viral Suppression Trends Over Time Among HIV-Infected Patients Receiving Care in the United States, 1997 to 2015: A Cohort Study.

Author information

1
University of Washington, Seattle, Washington (R.M.N., J.C.D., J.M.S., B.M.W., F.M.A., R.J.F., M.M.K., H.M.C.).
2
Brown University, Providence, Rhode Island (I.B.W.).
3
Harvard Medical School and Fenway Institute, Boston, Massachusetts (K.H.M.).
4
University of Miami, Miami, Florida, and Fenway Institute, Boston, Massachusetts (S.A.S.).
5
University of Alabama at Birmingham, Birmingham, Alabama (M.J.M., M.S.S.).
6
University of California, San Diego, San Diego, California (W.C.M.).
7
University of California, San Francisco, San Francisco, California (K.A.C.).
8
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.J.E., S.N.).
9
Johns Hopkins University, Baltimore, Maryland (R.D.M., B.L.).
10
Case Western Reserve University, Cleveland, Ohio (B.R.).

Abstract

Background:

Because HIV viral suppression is essential for optimal outcomes and prevention efforts, understanding trends and predictors is imperative to inform public health policy.

Objective:

To evaluate viral suppression trends in people living with HIV (PLWH), including the relationship of associated factors, such as demographic characteristics and integrase strand transfer inhibitor (ISTI) use.

Design:

Longitudinal observational cohort study.

Setting:

8 HIV clinics across the United States.

Participants:

PLWH receiving clinical care.

Measurements:

To understand trends in viral suppression (≤400 copies/mL), annual viral suppression rates from 1997 to 2015 were determined. Analyses were repeated with tests limited to 1 random test per person per year and using inverse probability of censoring weights to address loss to follow-up. Joint longitudinal and survival models and linear mixed models of PLWH receiving antiretroviral therapy (ART) were used to examine associations between viral suppression or continuous viral load (VL) levels and demographic factors, substance use, adherence, and ISTI use.

Results:

Viral suppression increased from 32% in 1997 to 86% in 2015 on the basis of all tests among 31 930 PLWH. In adjusted analyses, being older (odds ratio [OR], 0.76 per decade [95% CI, 0.74 to 0.78]) and using an ISTI-based regimen (OR, 0.54 [CI, 0.51 to 0.57]) were associated with lower odds of having a detectable VL, and black race was associated with higher odds (OR, 1.68 [CI, 1.57 to 1.80]) (P < 0.001 for each). Similar patterns were seen with continuous VL levels; when analyses were limited to 2010 to 2015; and with adjustment for adherence, substance use, or depression.

Limitation:

Results are limited to PLWH receiving clinical care.

Conclusion:

HIV viral suppression rates have improved dramatically across the United States, which is likely partially attributable to improved ART, including ISTI-based regimens. However, disparities among younger and black PLWH merit attention.

Primary Funding Source:

National Institutes of Health.

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