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Disparities in viral suppression identified in large urban cohort
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BOSTON — Researchers identified disparities in viral suppression among a large urban cohort of HIV-infected patients with regard to race, sex, and social and economic factors, according to new findings presented here at the 2014 Conference on Retroviruses and Opportunistic Infections.
“We know from a variety of studies that have been done in the United States that as few as a third of people who are HIV-infected are able to achieve viral suppression,” Amanda D. Castel, MD, MPH, associate professor in the department of epidemiology and biostatistics at The George Washington University, said during a press conference. “People who are not suppressed have poor clinical outcomes and potential to transmit the virus to others. We also know that disparities exist among certain subpopulations with regard to treatment access.”
Amanda D. Castel
To identify potential disparities in viral suppression, Castel and colleagues analyzed data from 2,644 HIV-infected men, women and children receiving care at 13 participating clinics in Washington, D.C., between 2011 and 2013. Participants completed at least two viral load measurements throughout the study period and had a history of receiving antiretrovirals. The researchers used multivariable regression analyses to identify factors associated with viral suppression, which was defined in the study as having 200 copies/mL or less at the time of enrollment or at the most recent viral load measurement.
According to the researchers, the results were somewhat optimistic, with 93% of the cohort achieving viral suppression at the time of enrollment or at the most recent viral load measurement. More than 60% were able to maintain viral suppression over the 3-year observation period.
Most of the patients in the study were black (75%) and male (75%), with a median age of 47 years. Forty percent of the cohort was infected through male-to-male sexual contact. A large majority of patients (92%) were prescribed antiretroviral treatment, with a median treatment duration of approximately 4 years.
Initial analyses indicated that patients who did not achieve viral suppression shared the following characteristics: more likely to be black; female; younger age; live in temporary housing; use public insurance; have comorbid substance use disorders.
Controlling for factors that included use of antiretroviral therapy, the researchers found that blacks (adjusted OR=0.27; 95% CI: 0.08- 0.90), younger individuals (adjusted OR=1.18; 95% CI: 1.04-1.33 per 5-year increase), heterosexually infected (adjusted OR=0.49; 95%CI: 0.26-0.95), and perinatally infected participants (adjusted OR=0.33; 95%CI:0.14-0.78) remained significantly less likely to achieve viral suppression. Blacks were almost twice as likely to experience virologic failure compared with other ethnicities. Among those who did not achieve viral suppression, the median viral load ranged from 5,000 to 13,000 copies/mL, with approximately 17% having viral loads that were greater than 100,000 copies/mL at some point during the study.
In the multivariable analyses, viral suppression was not significantly associated with insurance status, employment status, the duration of a patient’s HIV infection or comorbid medical conditions, including hepatitis B and C infections, depression and diabetes.
“We know that disparities in viral suppression by race and mode of transmission have been previously described, and we know that blacks and heterosexuals are less likely to engage in care than their counterparts,” Castel said. “The lower likelihood of achieving viral suppression among younger participants and those perinatally infected may be explained by limited availability of treatment options, duration on antiretrovirals or the development of resistance. Therefore, we intend to do further analyses, to look at things like ART exposure, specific regimens and the prevalence of drug resistance, which might provide further insight into these disparities.” – by John Schoen
For more information:
Castel AD. Abstract #993. Presented at: CROI 2014; March 3-6, 2013; Boston.
Disclosure: The researchers report no relevant financial disclosures.