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Earlier stage at diagnosis not related to increased HIV viral suppression
Fewer patients with stage 1 or stage 2 HIV disease at diagnosis reached viral suppression compared with those who had stage 3 disease, according to data from a study conducted in Georgia.
National HIV treatment guidelines changed in March 2012 to recommend initiating antiretroviral therapy in all patients regardless of stage, investigators from the Georgia Department of Public Health wrote in MMWR. Previously, ART was only recommended for patients with advanced disease.
Among those with stage 3 disease (CD4 counts <200 cells/mm3 at diagnosis), 80.5% met the criteria for viral suppression within 15 months of diagnosis. Among those with stage 2 disease (CD4 counts of 200 cells/mm3 to 499 cells/mm3), 72.3% reached viral suppression. Among those with stage 1 disease (CD4 counts ≥500 cells/mm3), 64.5% reached viral suppression.
“These data can serve as a baseline to determine the impact of the guideline change in the future, and can be used to emphasize the importance of implementing the guidelines by expanding treatment to persons at all disease stages to reach the goal of viral suppression for all person with HIV, thus closing the gap in viral suppression among persons diagnoses at stages 1 and 2,” the investigators wrote.
In 2010, there were 2,921 new HIV infections diagnosed among people in Georgia aged at least 13 years. Among those, 1,340 (45.9%) were retained in care, and among those, 958 (71.5%) reached viral suppression. Black patients and those aged 13 to 24 years had the lowest prevalence of viral suppression. According to transmission category, those men infected by male-to-male sexual contact and injection drug use had the lowest prevalence of viral suppression, as did women with heterosexual contact.
“All state or local health departments should monitor the continuum of care for persons living with HIV in their jurisdiction to determine care and treatment needs and evaluate public health interventions and implementation of treatment guidelines,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.