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High Levels of Antiretroviral Use and Viral Suppression Among Persons in HIV Care in the United States, 2010

Dombrowski, Julia C. MD, MPH*,†; Kitahata, Mari M. MD, MPH*; Van Rompaey, Stephen E. PhD*; Crane, Heidi M. MD, MPH*; Mugavero, Michael J. MD, MHSc; Eron, Joseph J. MD§; Boswell, Stephen L. MD‖,¶; Rodriguez, Benigno MD#; Mathews, W. Christopher MD**; Martin, Jeffrey N. MD, MPH††,‡‡; Moore, Richard D. MD, MHS§§,‖‖,¶¶; Golden, Matthew R. MD, MPH*,†,##

JAIDS Journal of Acquired Immune Deficiency Syndromes: 1 July 2013 - Volume 63 - Issue 3 - p 299–306
doi: 10.1097/QAI.0b013e3182945bc7
Clinical Science

Background: Contemporary data on patterns of antiretroviral therapy (ART) use in the United States are needed to inform efforts to improve the HIV care cascade.

Methods: We conducted a cross-sectional study of patients in the Centers for AIDS Research Network of Integrated Clinical Systems cohort who were in HIV care in 2010 to assess ART use and outcomes, stratified by nadir CD4 count (≤350, 351–500, or >500 cells/mm3), demographics, psychiatric diagnoses, substance use, and engagement in continuous care (≥2 visits ≥3 months apart in 2010).

Results: Of 8633 patients at 7 sites who had ≥1 medical visit and ≥1 viral load in 2010, 94% had ever initiated ART, 89% were on ART, and 70% had an undetectable viral load at the end of 2010. Fifty percent of ART-naive patients had nadir CD4 counts >500 cells per cubic millimeter, but this group comprised just 3% of the total population. Among patients who were ART naive at the time of cohort entry (N = 4637), both ART initiation and viral suppression were strongly associated with nadir CD4 count. Comparing 2009 and 2010, the percentages of patients with viral suppression among those with nadir CD4 counts 351–500 and >500 cells per cubic millimeter were 44% vs. 57% and 25% vs. 33%, respectively. Engagement in care was the only factor consistently associated with ART use and viral suppression across nadir CD4 count strata.

Conclusions: Our findings suggest that ART use and viral suppression among persons in HIV care may be more common than estimated in some previous studies and increased from 2009 to 2010.

*Department of Medicine, University of Washington, Seattle, WA;

Public Health–Seattle & King County, HIV/STD Program, Seattle, WA;

Department of Medicine, University of Alabama at Birmingham, Birmingham, AL;

§Departments of Medicine and Epidemiology, University of North Carolina, Chapel Hill, NC;

Fenway Community Health;

Department of Medicine, Harvard Medical School, Boston, MA;

#Department of Medicine, Case Western Reserve University, Cleveland, OH;

**Department of Medicine, University of California, San Diego, CA;

Departments of ††Medicine;

‡‡Epidemiology, University of California, San Francisco, CA;

Departments of §§Medicine;

‖‖Epidemiology;

¶¶Center for Global Health, Johns Hopkins University School of Medicine, Baltimore, MD; and

##Department of Epidemiology, University of Washington, Seattle, WA.

Correspondence to: Julia C. Dombrowski, MD, MPH, Department of Medicine, Public Health Seattle & King County, Harborview Medical Center, 325 Ninth Avenue, Box 359777, Seattle, WA 98104 (e-mail: jdombrow@uw.edu).

Presented in part at the 48th Meeting of the Infectious Diseases Society of America in Vancouver, British Columbia, 2010.

Supported by National Institutes of Health (NIH) grants T32 AI07140-31 and K23MH090923 to J.C.D. and K23MH082641-05 to M.J.M., the University of Washington Center for AIDS Research, an NIH funded program (P30 AI027757), which is supported by the following NIH Institutes and Centers: National Institute of Allergy and Infectious Diseases, National Career Institute, National Institutes of Mental Health, National Institute on Drug Abuse, National Institute of Child Health and Human Development, National Heart, Lung, and Blood Institute, National Institute on Aging; the UAB Center for AIDS Research (P30-AI027767) and by an NIH grant for the CFAR-Network of Integrated Clinical Systems (R24AI067039). M.J.M. has received grants and/or consultancy fees from Bristol-Myers Squibb, Merck Foundation, Tibotec Therapeutics, Pfizer, Definicare, and Gilead Sciences. J.J.E. has received grants and/or consultancy fees from Merck, Bristol-Myers Squibb, Glaxo-Smith-Klein/ViiV, Gilead Sciences, and Tibotec Therapeutics/Janssen. M.R.G. has received free medications and test kits for research studies from Pfizer and Gen-Probe.

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Received September 28, 2012

Accepted March 27, 2013

© 2013 Lippincott Williams & Wilkins, Inc.