Viremia Trajectories of HIV in HIV-Positive Women in the United States, 1994-2017

Seble G. Kassaye, Cuiwei Wang, Joanne Michelle F. Ocampo, Tracey E. Wilson, Kathryn Anastos, Mardge Cohen, Ruth M. Greenblatt, Margaret A Fischl, Igho Otofukun, Adaora Adimora, Mirjam Colette Kempf, Gerald B. Sharp, Mary Young, Michael Plankey

Research output: Contribution to journalArticle

Abstract

Importance: Viral suppression of HIV is an important treatment goal to decrease morbidity, mortality, and risk of transmission to others. Objective: To characterize longitudinal HIV viral load outcomes among women enrolled in the Women's Interagency HIV Study (WIHS). Design, Setting, and Participants: A prospective cohort study of HIV-positive women with semiannual study visits and a minimum of 5 follow-up visits was conducted from 1994 to 2017. The WIHS sites included in this analysis are in Brooklyn and Bronx, New York; Chicago, Illinois; San Francisco, California; and Washington, DC. Main Outcomes and Measures: Women were categorized into groups based on their probability of achieving viral load suppression below 200 copies/mL using logistic trajectory modeling. Multinomial regression analysis was used to identify factors associated with placement in the group with the highest probability of viremia. Results: At baseline, the mean (SD) age of the 1989 women was 36.9 (8.0) years, mean CD4+ T-lymphocyte count was 467/mm3, median (interquartile range) HIV RNA was 6200.0 (384.5-41 678.0) copies/mL, and 1305 women (65.6%) were African American. Three trajectory groups were identified with low (568 [28.6%]), intermediate (784 [39.4%]), and high (637 [32.0%]) probability of viremia above 200 copies/mL. The mean (SD) cumulative years of viral suppression were 18.7 (4.0) years, 12.2 (3.1) years, and 5.8 (2.9) years in the respective groups. Factors associated with high probability of viremia included younger age (odds ratio [OR]. 0.99; 95% CI, 0.98-0.99; P = .03), African American race (odds ratio [OR], 2.43; 95% CI, 1.75-3.37), P < .001), Hispanic race/ethnicity (OR, 1.50; 95% CI, 1.03-2.19; P = .04), increased levels of depressive symptoms (OR, 1.17; 95% CI, 1.01-1.36; P = .03), drug use (OR, 1.23; 95% CI, 1.01-1.51; P = .04), lower CD4+ T-lymphocyte counts (OR, 95% CI, 0.82; 0.80-0.85; P < .001), and unstable housing (OR, 1.25, 95% CI, 1.03-1.50; P = .02). Between 2015 and 2017, 71.2% of women demonstrated sustained viral suppression: 89.6% (310 of 346) of those with low viremia, 83.4% (346 of 415) with intermediate, and 35.2% (112 of 318) with high probability of viremia. Conclusions and Relevance: This longitudinal approach suggested that the probability of viremia decreased substantially over time for most participants, including among women with earlier histories of incomplete viral suppression. The findings from this study suggest that continued efforts are needed to address mental health, social, behavioral and structural factors that were identified as associated with high probability of HIV viremia over time.

Original languageEnglish (US)
Pages (from-to)e193822
JournalJAMA Network Open
Volume2
Issue number5
DOIs
StatePublished - May 3 2019

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Viremia
HIV
Odds Ratio
CD4 Lymphocyte Count
Viral Load
African Americans
T-Lymphocytes
San Francisco
Hispanic Americans
Mental Health
Cohort Studies
Regression Analysis
Outcome Assessment (Health Care)
Prospective Studies
RNA
Depression
Morbidity
Mortality

Cite this

Kassaye, S. G., Wang, C., Ocampo, J. M. F., Wilson, T. E., Anastos, K., Cohen, M., ... Plankey, M. (2019). Viremia Trajectories of HIV in HIV-Positive Women in the United States, 1994-2017. JAMA Network Open, 2(5), e193822. https://doi.org/10.1001/jamanetworkopen.2019.3822

Viremia Trajectories of HIV in HIV-Positive Women in the United States, 1994-2017. / Kassaye, Seble G.; Wang, Cuiwei; Ocampo, Joanne Michelle F.; Wilson, Tracey E.; Anastos, Kathryn; Cohen, Mardge; Greenblatt, Ruth M.; Fischl, Margaret A; Otofukun, Igho; Adimora, Adaora; Kempf, Mirjam Colette; Sharp, Gerald B.; Young, Mary; Plankey, Michael.

In: JAMA Network Open, Vol. 2, No. 5, 03.05.2019, p. e193822.

Research output: Contribution to journalArticle

Kassaye, SG, Wang, C, Ocampo, JMF, Wilson, TE, Anastos, K, Cohen, M, Greenblatt, RM, Fischl, MA, Otofukun, I, Adimora, A, Kempf, MC, Sharp, GB, Young, M & Plankey, M 2019, 'Viremia Trajectories of HIV in HIV-Positive Women in the United States, 1994-2017', JAMA Network Open, vol. 2, no. 5, pp. e193822. https://doi.org/10.1001/jamanetworkopen.2019.3822
Kassaye SG, Wang C, Ocampo JMF, Wilson TE, Anastos K, Cohen M et al. Viremia Trajectories of HIV in HIV-Positive Women in the United States, 1994-2017. JAMA Network Open. 2019 May 3;2(5):e193822. https://doi.org/10.1001/jamanetworkopen.2019.3822
Kassaye, Seble G. ; Wang, Cuiwei ; Ocampo, Joanne Michelle F. ; Wilson, Tracey E. ; Anastos, Kathryn ; Cohen, Mardge ; Greenblatt, Ruth M. ; Fischl, Margaret A ; Otofukun, Igho ; Adimora, Adaora ; Kempf, Mirjam Colette ; Sharp, Gerald B. ; Young, Mary ; Plankey, Michael. / Viremia Trajectories of HIV in HIV-Positive Women in the United States, 1994-2017. In: JAMA Network Open. 2019 ; Vol. 2, No. 5. pp. e193822.
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abstract = "Importance: Viral suppression of HIV is an important treatment goal to decrease morbidity, mortality, and risk of transmission to others. Objective: To characterize longitudinal HIV viral load outcomes among women enrolled in the Women's Interagency HIV Study (WIHS). Design, Setting, and Participants: A prospective cohort study of HIV-positive women with semiannual study visits and a minimum of 5 follow-up visits was conducted from 1994 to 2017. The WIHS sites included in this analysis are in Brooklyn and Bronx, New York; Chicago, Illinois; San Francisco, California; and Washington, DC. Main Outcomes and Measures: Women were categorized into groups based on their probability of achieving viral load suppression below 200 copies/mL using logistic trajectory modeling. Multinomial regression analysis was used to identify factors associated with placement in the group with the highest probability of viremia. Results: At baseline, the mean (SD) age of the 1989 women was 36.9 (8.0) years, mean CD4+ T-lymphocyte count was 467/mm3, median (interquartile range) HIV RNA was 6200.0 (384.5-41 678.0) copies/mL, and 1305 women (65.6{\%}) were African American. Three trajectory groups were identified with low (568 [28.6{\%}]), intermediate (784 [39.4{\%}]), and high (637 [32.0{\%}]) probability of viremia above 200 copies/mL. The mean (SD) cumulative years of viral suppression were 18.7 (4.0) years, 12.2 (3.1) years, and 5.8 (2.9) years in the respective groups. Factors associated with high probability of viremia included younger age (odds ratio [OR]. 0.99; 95{\%} CI, 0.98-0.99; P = .03), African American race (odds ratio [OR], 2.43; 95{\%} CI, 1.75-3.37), P < .001), Hispanic race/ethnicity (OR, 1.50; 95{\%} CI, 1.03-2.19; P = .04), increased levels of depressive symptoms (OR, 1.17; 95{\%} CI, 1.01-1.36; P = .03), drug use (OR, 1.23; 95{\%} CI, 1.01-1.51; P = .04), lower CD4+ T-lymphocyte counts (OR, 95{\%} CI, 0.82; 0.80-0.85; P < .001), and unstable housing (OR, 1.25, 95{\%} CI, 1.03-1.50; P = .02). Between 2015 and 2017, 71.2{\%} of women demonstrated sustained viral suppression: 89.6{\%} (310 of 346) of those with low viremia, 83.4{\%} (346 of 415) with intermediate, and 35.2{\%} (112 of 318) with high probability of viremia. Conclusions and Relevance: This longitudinal approach suggested that the probability of viremia decreased substantially over time for most participants, including among women with earlier histories of incomplete viral suppression. The findings from this study suggest that continued efforts are needed to address mental health, social, behavioral and structural factors that were identified as associated with high probability of HIV viremia over time.",
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T1 - Viremia Trajectories of HIV in HIV-Positive Women in the United States, 1994-2017

AU - Kassaye, Seble G.

AU - Wang, Cuiwei

AU - Ocampo, Joanne Michelle F.

AU - Wilson, Tracey E.

AU - Anastos, Kathryn

AU - Cohen, Mardge

AU - Greenblatt, Ruth M.

AU - Fischl, Margaret A

AU - Otofukun, Igho

AU - Adimora, Adaora

AU - Kempf, Mirjam Colette

AU - Sharp, Gerald B.

AU - Young, Mary

AU - Plankey, Michael

PY - 2019/5/3

Y1 - 2019/5/3

N2 - Importance: Viral suppression of HIV is an important treatment goal to decrease morbidity, mortality, and risk of transmission to others. Objective: To characterize longitudinal HIV viral load outcomes among women enrolled in the Women's Interagency HIV Study (WIHS). Design, Setting, and Participants: A prospective cohort study of HIV-positive women with semiannual study visits and a minimum of 5 follow-up visits was conducted from 1994 to 2017. The WIHS sites included in this analysis are in Brooklyn and Bronx, New York; Chicago, Illinois; San Francisco, California; and Washington, DC. Main Outcomes and Measures: Women were categorized into groups based on their probability of achieving viral load suppression below 200 copies/mL using logistic trajectory modeling. Multinomial regression analysis was used to identify factors associated with placement in the group with the highest probability of viremia. Results: At baseline, the mean (SD) age of the 1989 women was 36.9 (8.0) years, mean CD4+ T-lymphocyte count was 467/mm3, median (interquartile range) HIV RNA was 6200.0 (384.5-41 678.0) copies/mL, and 1305 women (65.6%) were African American. Three trajectory groups were identified with low (568 [28.6%]), intermediate (784 [39.4%]), and high (637 [32.0%]) probability of viremia above 200 copies/mL. The mean (SD) cumulative years of viral suppression were 18.7 (4.0) years, 12.2 (3.1) years, and 5.8 (2.9) years in the respective groups. Factors associated with high probability of viremia included younger age (odds ratio [OR]. 0.99; 95% CI, 0.98-0.99; P = .03), African American race (odds ratio [OR], 2.43; 95% CI, 1.75-3.37), P < .001), Hispanic race/ethnicity (OR, 1.50; 95% CI, 1.03-2.19; P = .04), increased levels of depressive symptoms (OR, 1.17; 95% CI, 1.01-1.36; P = .03), drug use (OR, 1.23; 95% CI, 1.01-1.51; P = .04), lower CD4+ T-lymphocyte counts (OR, 95% CI, 0.82; 0.80-0.85; P < .001), and unstable housing (OR, 1.25, 95% CI, 1.03-1.50; P = .02). Between 2015 and 2017, 71.2% of women demonstrated sustained viral suppression: 89.6% (310 of 346) of those with low viremia, 83.4% (346 of 415) with intermediate, and 35.2% (112 of 318) with high probability of viremia. Conclusions and Relevance: This longitudinal approach suggested that the probability of viremia decreased substantially over time for most participants, including among women with earlier histories of incomplete viral suppression. The findings from this study suggest that continued efforts are needed to address mental health, social, behavioral and structural factors that were identified as associated with high probability of HIV viremia over time.

AB - Importance: Viral suppression of HIV is an important treatment goal to decrease morbidity, mortality, and risk of transmission to others. Objective: To characterize longitudinal HIV viral load outcomes among women enrolled in the Women's Interagency HIV Study (WIHS). Design, Setting, and Participants: A prospective cohort study of HIV-positive women with semiannual study visits and a minimum of 5 follow-up visits was conducted from 1994 to 2017. The WIHS sites included in this analysis are in Brooklyn and Bronx, New York; Chicago, Illinois; San Francisco, California; and Washington, DC. Main Outcomes and Measures: Women were categorized into groups based on their probability of achieving viral load suppression below 200 copies/mL using logistic trajectory modeling. Multinomial regression analysis was used to identify factors associated with placement in the group with the highest probability of viremia. Results: At baseline, the mean (SD) age of the 1989 women was 36.9 (8.0) years, mean CD4+ T-lymphocyte count was 467/mm3, median (interquartile range) HIV RNA was 6200.0 (384.5-41 678.0) copies/mL, and 1305 women (65.6%) were African American. Three trajectory groups were identified with low (568 [28.6%]), intermediate (784 [39.4%]), and high (637 [32.0%]) probability of viremia above 200 copies/mL. The mean (SD) cumulative years of viral suppression were 18.7 (4.0) years, 12.2 (3.1) years, and 5.8 (2.9) years in the respective groups. Factors associated with high probability of viremia included younger age (odds ratio [OR]. 0.99; 95% CI, 0.98-0.99; P = .03), African American race (odds ratio [OR], 2.43; 95% CI, 1.75-3.37), P < .001), Hispanic race/ethnicity (OR, 1.50; 95% CI, 1.03-2.19; P = .04), increased levels of depressive symptoms (OR, 1.17; 95% CI, 1.01-1.36; P = .03), drug use (OR, 1.23; 95% CI, 1.01-1.51; P = .04), lower CD4+ T-lymphocyte counts (OR, 95% CI, 0.82; 0.80-0.85; P < .001), and unstable housing (OR, 1.25, 95% CI, 1.03-1.50; P = .02). Between 2015 and 2017, 71.2% of women demonstrated sustained viral suppression: 89.6% (310 of 346) of those with low viremia, 83.4% (346 of 415) with intermediate, and 35.2% (112 of 318) with high probability of viremia. Conclusions and Relevance: This longitudinal approach suggested that the probability of viremia decreased substantially over time for most participants, including among women with earlier histories of incomplete viral suppression. The findings from this study suggest that continued efforts are needed to address mental health, social, behavioral and structural factors that were identified as associated with high probability of HIV viremia over time.

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