TY - JOUR
T1 - HIV viral suppression trends over time among HIV-infected patients receiving care in the United States, 1997 to 2015 a cohort study
AU - Nance, Robin M.
AU - Chris Delaney, J. A.
AU - Simoni, Jane M.
AU - Wilson, Ira B.
AU - Mayer, Kenneth H.
AU - Whitney, Bridget M.
AU - Aunon, Frances M.
AU - Safren, Steven A.
AU - Mugavero, Michael J.
AU - Christopher Mathews, W.
AU - Christopoulos, Katerina A.
AU - Eron, Joseph J.
AU - Napravnik, Sonia
AU - Moore, Richard D.
AU - Rodriguez, Benigno
AU - Lau, Bryan
AU - Fredericksen, Rob J.
AU - Saag, Michael S.
AU - Kitahata, Mari M.
AU - Crane, Heidi M.
N1 - Funding Information:
Disclosures: Dr. Wilson reports consulting fees from Pfizer outside the submitted work. Dr. Mayer reports grants from Gilead Sciences and ViiV Healthcare outside the submitted work. Dr. Mugavero reports personal fees from the Gilead Foundation and a grant from Bristol-Myers Squibb outside the submitted work. Dr. Christopoulos reports grants and personal fees from Gilead and personal fees from Roche outside the submitted work. Dr. Eron reports personal fees from Merck and grants and personal fees from ViiV Healthcare, Janssen Pharmaceutical, Gilead Sciences, and Bristol-Myers Squibb outside the submitted work. Dr. Moore reports personal fees from Medscape outside the submitted work. Dr. Rodriguez reports personal fees from Gilead during the conduct of the study. Dr. Saag reports grants from Merck, Bristol-Myers Squibb, Gilead, ViiV Healthcare, AbbVie, and Proteus and personal fees from Merck, Bristol-Myers Squibb, and Gilead outside the submitted work. Dr. Crane reports a grant from ViiV Healthcare outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje /ConflictOfInterestForms.do?msNum=M17-2242.
Funding Information:
Grant Support: This work was supported by the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health (U24AA020801, U01AA020793, and U01AA020802). Additional support came from the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (CNICS R24 AI067039, UW CFAR NIAID Grant P30 AI027757, UNC CFAR grant P30 AI50410, JHU CFAR grant P30 AI094189, Providence/Boston CFAR grant P30 AI042853, and UAB CFAR grant P30 AI027767), the National Institute of General Medical Sciences (U54 GM115677), and the National Institute on Drug Abuse (DA U01036935).
Publisher Copyright:
© 2018 American College of Physicians
PY - 2018/9/18
Y1 - 2018/9/18
N2 - Background: Because HIV viral suppression is essential for optimal outcomes and prevention efforts, understanding trends and predictors is imperative to inform public health policy. Objective: To evaluate viral suppression trends in people living with HIV (PLWH), including the relationship of associated factors, such as demographic characteristics and integrase strand transfer inhibitor (ISTI) use. Design: Longitudinal observational cohort study. Setting: 8 HIV clinics across the United States. Participants: PLWH receiving clinical care. Measurements: To understand trends in viral suppression (≤400 copies/mL), annual viral suppression rates from 1997 to 2015 were determined. Analyses were repeated with tests limited to 1 random test per person per year and using inverse probability of censoring weights to address loss to follow-up. Joint longitudinal and survival models and linear mixed models of PLWH receiving antiretroviral therapy (ART) were used to examine associations between viral suppression or continuous viral load (VL) levels and demographic factors, substance use, adherence, and ISTI use. Results: Viral suppression increased from 32% in 1997 to 86% in 2015 on the basis of all tests among 31 930 PLWH. In adjusted analyses, being older (odds ratio [OR], 0.76 per decade [95% CI, 0.74 to 0.78]) and using an ISTI-based regimen (OR, 0.54 [CI, 0.51 to 0.57]) were associated with lower odds of having a detectable VL, and black race was associated with higher odds (OR, 1.68 [CI, 1.57 to 1.80]) (P < 0.001 for each). Similar patterns were seen with continuous VL levels; when analyses were limited to 2010 to 2015; and with adjustment for adherence, substance use, or depression. Limitation: Results are limited to PLWH receiving clinical care. Conclusion: HIV viral suppression rates have improved dramatically across the United States, which is likely partially attributable to improved ART, including ISTI-based regimens. However, disparities among younger and black PLWH merit attention.
AB - Background: Because HIV viral suppression is essential for optimal outcomes and prevention efforts, understanding trends and predictors is imperative to inform public health policy. Objective: To evaluate viral suppression trends in people living with HIV (PLWH), including the relationship of associated factors, such as demographic characteristics and integrase strand transfer inhibitor (ISTI) use. Design: Longitudinal observational cohort study. Setting: 8 HIV clinics across the United States. Participants: PLWH receiving clinical care. Measurements: To understand trends in viral suppression (≤400 copies/mL), annual viral suppression rates from 1997 to 2015 were determined. Analyses were repeated with tests limited to 1 random test per person per year and using inverse probability of censoring weights to address loss to follow-up. Joint longitudinal and survival models and linear mixed models of PLWH receiving antiretroviral therapy (ART) were used to examine associations between viral suppression or continuous viral load (VL) levels and demographic factors, substance use, adherence, and ISTI use. Results: Viral suppression increased from 32% in 1997 to 86% in 2015 on the basis of all tests among 31 930 PLWH. In adjusted analyses, being older (odds ratio [OR], 0.76 per decade [95% CI, 0.74 to 0.78]) and using an ISTI-based regimen (OR, 0.54 [CI, 0.51 to 0.57]) were associated with lower odds of having a detectable VL, and black race was associated with higher odds (OR, 1.68 [CI, 1.57 to 1.80]) (P < 0.001 for each). Similar patterns were seen with continuous VL levels; when analyses were limited to 2010 to 2015; and with adjustment for adherence, substance use, or depression. Limitation: Results are limited to PLWH receiving clinical care. Conclusion: HIV viral suppression rates have improved dramatically across the United States, which is likely partially attributable to improved ART, including ISTI-based regimens. However, disparities among younger and black PLWH merit attention.
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U2 - 10.7326/M17-2242
DO - 10.7326/M17-2242
M3 - Review article
C2 - 30140916
AN - SCOPUS:85053559893
VL - 169
SP - 376
EP - 384
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
SN - 0003-4819
IS - 6
ER -