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HIV viral suppression rates nearly triple in US, disparities remain

HIV viral suppression rates nearly tripled across the United States over the past 2 decades, but disparities among younger patients and black individuals living with HIV remain, according to a study appearing in Annals of Internal Medicine.

The researchers speculated that the improved suppression rates are likely partially attributable to improvements in antiretroviral therapy (ART), particularly integrase strand transfer inhibitor (ISTI)-based regimens.

“Approximately 1.2 million adults are living with HIV in the United States, with a disproportionate burden among men who have sex with men and among African-Americans,” Robin M. Nance, MS, from the University of Washington, and colleagues wrote. “Achieving and maintaining HIV viral suppression with ART can optimize health outcomes among [people living with HIV] and limit transmission to others. Monitoring viral suppression is thus an important aspect of HIV care. Identifying predictors of nonsuppression and groups at increased risk for it can enhance intervention efforts.”

Nance and colleagues conducted a longitudinal observational cohort study of eight HIV clinics across the United States to evaluate viral suppression trends in patients with HIV. Researchers used joint longitudinal and survival models and linear mixed models of patients with HIV receiving ART to examine association between viral suppression and demographic factors, substance use, adherence and ISTI use.

The researchers analyzed 31,930 patients with HIV and found that viral suppression increased from 32% in 1997 to 86% in 2015. Black race was associated with higher odds (OR = 1.68; 95% CI, 1.57-1.8) of a detectable viral load. Researchers also found that the odds of having a detectable continuous viral load were lower among older patients (OR = 0.76 per decade; 95% CI, 0.74-0.78) and patients using an ISTI-based regimen (OR = 0.54; 95% CI, 0.51-0.57).

“More widespread ART use, including initiation of ART, was the most important driver of viral suppression among [people living with HIV],” the researchers wrote. “However, among those receiving ART, we found that ISTI use increased and was likely an important contributing factor to viral suppression. This was true in all sensitivity models, including those limited to patients who were known to be ART-naive when they initiated care.”

In an accompanying editorial, Hilary D. Marston, MD, MPH, of the National Institute of Allergy and Infectious Diseases, and colleagues wrote that Nance and colleagues’ research helps to better understand the viral suppression gap.

However, they noted that populations with significant disparities are difficult to study because they “have already fallen through the proverbial cracks.”

“As we strive to end the HIV epidemic in the United States, targeted treatment interventions for populations with low levels of viral suppression, paired with tailored prevent packages, will be essential,” Marston and colleagues wrote. “Further studies, such as that of Nance and colleagues, will be critical in identifying the disparities that must be address these implementation gaps.” – by Jake Scott

Disclosures: Nance reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.