Durable Viral Suppression and Transmission Risk Potential Among Persons With Diagnosed HIV Infection: United States, 2012–2013

• Published in: Clinical infectious diseases Vol. 63; no. 7; pp. 976 - 983
• Main Authors: Crepaz, Nicole, Tang, Tian, Marks, Gary, Mugavero, Michael J., Espinoza, Lorena, Hall, H. Irene
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.10.2016
• Subjects: Adolescent; Adult; Anti-HIV Agents - therapeutic use; Disease transmission; Female; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - transmission; HIV Infections - virology; HIV-1; HIV/AIDS; Human immunodeficiency virus; Humans; Lentivirus; Male; Medical diagnosis; Middle Aged; Retroviridae; Risk; Risk factors; Sustained Virologic Response; United States - epidemiology; Viral Load; Young Adult; United States > US; USA; HIV-diagnosed persons; disparity; durable viral suppression; viral burden; HIV transmission risk
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciw418

Background. We examined durable viral suppression, cumulative viral load (VL) burden, and transmission risk potential among human immunodeficiency virus (HIV)–diagnosed persons in care. Methods. Using data from the National HIV Surveillance System from 17 jurisdictions with complete reporting of VL test results, we determined the percentage of persons in HIV care who achieved durable viral suppression (all VL results <200 copies/mL) and examined viremia copy-years and time spent above VL levels that increase the risk of HIV transmission during 2012–2013. Results. Of 265 264 persons in HIV care in 2011, 238 641 had at least 2 VLs in 2012–2013. The median number of VLs per individual during the 2-year period was 5. Approximately 62% had durable viral suppression. The remaining 38% had high VL burden (geometric mean of viremia copy-years, 7261) and spent an average of 438 days, 316 days, and 215 days (60%, 43.2%, and 29.5% of the 2-year period) above 200, 1500, and 10 000 copies/mL. Women, blacks/African Americans, Hispanics/Latinos, persons with HIV infection attributed to transmission other than male-to-male sexual contact, younger age groups, and persons with gaps in care had higher viral burden and transmission risk potential. Conclusions. Two-thirds of persons in HIV care had durable viral suppression during a 2-year period. One-third had high VL burden and spent substantial time above VL levels with increased risk of onward transmission. More intervention efforts are needed to improve retention in care and medication adherence so that more persons in HIV care achieve durable viral suppression.