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Local strategy significantly decreased viral load, newly diagnosed HIV in San Francisco

Issue: March 2011

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BOSTON — Efforts by the San Francisco Department of Public Health to offer universal treatment to all people with HIV has led to decreased clinical viral load and newly diagnosed HIV cases in the city between 2004 and 2009. Moupali Das, MD, MPH, said the success can be attributed to the improved ease, tolerability and availability of new ART therapy regimens, early initiation of treatment by clinicians and support for engagement and attention to care.

“The San Francisco Department of Public Health’s goal is to offer universal treatment to all people living with HIV in San Francisco and to support achieving virologic suppression as quickly as possible,” Das, assistant clinical professor in the divisions of HIV/AIDS and infectious diseases at San Francisco General Hospital Center for AIDS Prevention Studies, said during a press conference. “We have developed new metrics to evaluate this local HIV/AIDS strategy.”

The researchers pooled active case surveillance data from a comprehensive HIV/AIDS case registry on secular trends in mean CD4 count at diagnosis, ART initiation and time to virologic suppression. Mean CD4 count at diagnosis remained greater than 400 cells/mm (P=.077). Specifically, mean cell count at initiation of ART increased from 357 cells/mm to 445 cells/mm between 2007 and 2009.

Compared with a decreased time of 32 months from HIV diagnosis to virologic suppression during 2004, time from HIV diagnosis to virologic suppression was 5 months during 2009 (P<.001). Moreover, researchers observed a decrease in time from ART initiation to virologic suppression from 18.8 months during 2004 to 2.8 months during 2009 (P<.001).

Most recent community viral load significantly decreased between 2004 and 2009 (P<.001) and was significantly associated with decreases in newly diagnosed and reported HIV cases (P<.001).

“We have seen dramatic improvements in all markers during the past 5 years. Bottom line is, no matter how you measure clinical viral load, all measures are robustly associated with a decline in newly diagnosed and reported HIV cases,” Das said. “However, despite these successes there remains much more work to be done. Our mean CD4 count at diagnosis has remained in the 400s, indicating the urgent need to scale-up testing, and diagnose individuals earlier in the course of the disease. We believe that what gets measured gets managed.” – by Jennifer Henry

For more information:

• Das M. #1022. Presented at: 18th Conference on Retroviruses and Opportunistic Infections; Feb. 27-March 3, 2011; Boston.

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