Baseline Clinical Characteristics, Antiretroviral Therapy Use, and Viral Load Suppression Among HIV-Positive Young Men of Color Who Have Sex with Men

Abstract

Given the continued high incidence of HIV infection in the United States among racial/ethnic minority young men who have sex with men (YMSM), and an appreciation that antiretroviral therapy (ART) can provide personal and public health benefits, attention is needed to enhance the detection of HIV-infected youth and engage them in medical care and support services that encourage sustained HIV treatment and suppression of viremia. Poor retention in clinical care has been associated with higher mortality, an increase in HIV RNA, and decreased CD4 cell count. The goal of the current study was to evaluate the health care utilization and health outcomes of HIV-infected racial/ethnic minority YMSM enrolled in an outreach, linkage, and retention study funded by the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB). We hypothesized that among racial/ethnic minority YMSM, baseline CD4 counts and usage of ART are influenced by age, race, drug and alcohol use, and mental health symptoms. Overall, 155 subjects had at least a baseline CD4 count recorded at study entry. There was a low rate of ART use in this population with only one-half of the cohort with CD4 counts £ 350 cells/mm 3 being prescribed ART to treat their infection. However, of those youth who were started on ART, the majority (74%) did achieve undetectable viral loads ( < 400 copies). Given the continued increase in cases of HIV infection among racial/ethnic minority YMSM, efforts to increase both the provision of ART and support services that encourage adherence in this population are warranted.

Sexual Risk Behavior and Risk Reduction Beliefs Among HIV-Positive Young Men Who have Sex with Men

“…Despite the participants in the study being recruited from adolescent medicine clinical sites, there were relatively low proportions of participants that were on ART (47%), knew their CD4 count (59%), knew their viral load (39%), and that had an undetectable viral load (15%). We did not have access to actual clinical data in this study and relied on participant self-report for clinical markers, but these proportions are somewhat consistent with those reported in other recent samples of HIV-positive YMSM recruited from clinics [26]. …”

Understanding Structural Barriers to Accessing HIV Testing and Prevention Services Among Black Men Who Have Sex with Men (BMSM) in the United States

“…However, there is inconsistent evidence that HIV-positive BMSM have lower ART adherence than other HIV-positive MSM. Four studies found lower adherence among BMSM compared to other MSM [79–82], yet two other studies found no differences by race/ethnicity among MSM [83, 84] (Table 2). …”

Rates and Correlates of Antiretroviral Therapy Use and Virologic Suppression Among Perinatally and Behaviorally HIV-Infected Youth Linked to Care in the United States

“…10,11 In a cohort of HIV-infected young MSM of color, only one-half of the cohort with CD4 counts ≤350 cells/mm 3 had been prescribed ART. 12 Data from a large HIV clinical cohort indicated that between 2002–2008 only 69% of behaviorally infected youth (BIY) who met clinical criteria (having at least two CD4 measurements <350 cells/mm3) had initiated ART (compared to 79% of adults). 10 Recent CDC data indicate that African Americans aged 18–24 displayed the lowest level of viral suppression (18.3%) among all groups of individuals in the US.…”