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Time spent with HIV viral load above 1500 copies/ml among patients in HIV care, 2000–2014

Mendoza, Maria C.B.a; Gardner, Lytta; Armon, Carlb; Rose, Charles E.a; Palella, Frank J. Jr.c; Novak, Richard M.d; Tedaldi, Ellen M.e; Buchacz, Katea the HIV Outpatient Study Investigators

doi: 10.1097/QAD.0000000000001921
Epidemiology and Social
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Objective: Sexual HIV transmission is more likely to occur when plasma HIV RNA level (viral load) exceeds 1500 copies/ml. We assessed the percentage of person-time spent with viral load above 1500 copies/ml (pPT >1500) among adults with HIV in care.

Design: Observational cohort in eight United States HIV clinics.

Methods: Participants had at least one HIV Outpatient Study (HOPS) clinic visit and at least two viral loads during 2000–2014. We assessed pPT above 1500 in time intervals between consecutive viral load pairs, overall and by ART status. Trends in pPT above 1500 and associations between pPT above 1500 and chosen baseline demographics and clinical characteristics were analyzed using generalized estimating equations.

Results: There were 5873 patients contributing 37 794 person-years; 86.0% person-years had prescribed ART, with increasing coverage over time. Over 2000–2014 pPT above 1500 was 24.2%, decreasing from 38.3% in 2000–2002 to 11.3% in 2012–2014. During observation time with ART prescribed, pPT above 1500 was 16.4% overall, decreasing from 29.9% in 2000–2002 to 8.0% in 2012–2014. pPT above 1500 was higher in patients less than 35 vs. at least 50 years old (31.5 vs. 15.6%), women vs. men (30.8 vs. 22.3%), and black vs. white and Latino/Hispanic patients (32.7 vs. 19.9 and 23.7%, respectively). Multivariable correlates of higher pPT above 1500 included no prescribed ART, being younger, non-Hispanic black vs. white, baseline viral load above 1500 copies/ml or lower CD4+ count, and baseline public vs. private insurance.

Conclusion: pPT above 1500 declined during 2000–2014. Results support decreasing HIV transmission risk from persons in HIV care over the last decade, and the need to focus interventions on patient groups more consistently viremic.

aCenters for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia

bCerner Corp, Kansas City, Missouri

cNorthwestern University Feinberg School of Medicine, Chicago

dUniversity of Illinois, Chicago, Illinois

eLewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.

Correspondence to Maria C.B. Mendoza, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, M/S E-48 Atlanta, GA 30333, USA. Tel: +1 404 639 0987; e-mail: wyx1@cdc.gov

Received 20 February, 2018

Revised 31 May, 2018

Accepted 1 June, 2018

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Copyright © 2018 Wolters Kluwer Health, Inc.