‘Substantial efforts’ needed to reach viral suppression target for children with HIV
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Globally, children and adolescents on ART lag adults in progress toward achieving viral suppression, according to new data published in The Lancet HIV ahead of World AIDS Day, which is Dec. 1.
In 2014, UNAIDS announced global goals to control HIV by 2030, including the so-called “95-95-95 strategy,” in which 95% of people with HIV know their status, 95% of people with HIV are on ART, and 95% of people on treatment are virally suppressed.
“Viral suppression is an important indicator for many health outcomes in people with HIV, and it also reduces the risk of transmission to others,” Win Min Han, MBBS, MSc, a PhD student-researcher at the Kirby Institute of the University of New South Wales in Sydney, Australia, told Healio. “Many studies have reported the suppression rates from different parts of the world, but those reports did not account for missing viral load testing among people [who fell] of out care.”
Han and colleagues performed a retrospective cohort study using data from seven regional cohorts that included people who initiated ART between Jan.1, 2010, and Dec. 31, 2019, at 148 sites in 31 countries with annual viral load monitoring.
According to the study, only people with HIV who started ART after the time a site started routine viral load monitoring were included. The researchers analyzed data through March 31, 2020, and calculated the percentages of children and adults who were virally suppressed based on data from those who were alive, in follow-up and had viral load measurements for up to 3 years of ART.
Additionally, to provide insight on previously missing data regarding people who had fallen out of HIV care, the researchers analyzed a Zambian study of viral suppression rates in a similar population and calculated an adjustment to viral suppression rates.
The study included 21,594 children and adolescents from 106 sites in 22 countries and 255,662 adults from 143 sites in 30 countries. According to the researchers, an estimated 79% of adults were virally suppressed after 1 year of ART, 72% after 2 years and 65% after 3 years. Among children and adolescents, an estimated 64% were virally suppressed after 1 year of ART, 62% after 2 years and 59% after 3 years.
Based on these findings, “substantial efforts” are still needed to reach the viral suppression target for children and adolescents, the researchers wrote.
“The important take-home message is that our study clearly demonstrates the disparities in viral suppression between children and adults,” Han said. “Our study also highlights the importance of better retention in care strategies, especially among children and adolescents, and also the requirements of routine viral load monitoring among people on ART.”
References:
Too many people with HIV fail to achieve durable viral suppression. Published Nov. 30, 2021. Accessed Dec. 1, 2021. https://www.nih.gov/news-events/news-releases/too-many-people-hiv-fail-achieve-durable-viral-suppression.
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