Journal
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
Volume 59, Issue 1, Pages 86-93Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAI.0b013e318236f7d2
Keywords
HIV; viral load; retention in care; adherence; engagement in care
Categories
Funding
- National Institutes of Health [1R21AI087360-01, 3K23MH082641-02S1, 1R24AI067039-04, P30AI27767, 5K23MH090923-02]
- Bristol-Myers Squibb
- Gilead Sciences
- Merck Foundation
- Pfizer, Inc
- Tibotec Therapeutics
- Definicare LLC
- Ardea Biosciences
- Avexa
- Boehringer-Ingelheim
- GlaxoSmithKline
- Merck
- Monogram Biosciences
- Pain Therapeutics
- Panacos
- Pfizer
- Progenics
- Roche Laboratories
- Tibotec
- Tobira Therapeutics
- Vicro
- Achillion Pharmaceuticals
- Theratechnologies
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Background: After HIV diagnosis and linkage to care, achieving and sustaining viral load (VL) suppression has implications for patient outcomes and secondary HIV prevention. We evaluated factors associated with expeditious VL suppression and cumulative VL burden among patients establishing outpatient HIV care. Methods: Patients initiating HIV medical care from January 2007 to October 2010 at the University of Alabama at Birmingham and University of Washington were included. Multivariable Cox proportional hazards and linear regression models were used to evaluate factors associated with time to VL suppression (<50 copies/mL) and cumulative VL burden, respectively. Viremia copy-years, a novel area under the longitudinal VL curve measure, was used to estimate 2-year cumulative VL burden from clinic enrollment. Results: Among 676 patients, 63% achieved VL <50 copies per milliliter in a median 308 days. In multivariable analysis, patients with more time-updated no show visits experienced delayed VL suppression (hazard ratio = 0.84 per no show visit, 95% confidence interval = 0.76 to 0.92). In multivariable linear regression, visit nonadherence was independently associated with greater cumulative VL burden (log(10) viremia copy-years) during the first 2 years in care (Beta coefficient = 0.11 per 10% visit nonadherence, 95% confidence interval = 0.04 to 0.17). Across increasing visit adherence categories, lower cumulative VL burden was observed (mean +/- standard deviation log(10) copy x years/mL); 0%-79% adherence: 4.6 +/- 0.8; 80%-99% adherence: 4.3 +/- 0.7; and 100% adherence: 4.1 +/- 0.7 log(10) copy x years/mL, respectively (P < 0.01). Conclusions: Higher rates of early retention in HIV care are associated with achieving VL suppression and lower cumulative VL burden. These findings are germane for a test and treat approach to HIV prevention.
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