Cumulative plasma HIV burden disparities among adults in HIV care

Abstract

Although 95% of the cohort of adults in HIV care in San Francisco self-reported ART use during MMP interview, they spent on average almost 1 month per year at a transmittable viral level. We identified characteristics of those who were more likely to have higher viral burden, highlighting priorities for resource allocation to reduce onward HIV transmission.

Trends in Time Spent Viremic Among Persons Newly Diagnosed With HIV in San Francisco

“…Several studies have reported that PWID, PWID-MSM, younger persons, and homeless persons spent more time viremic compared with other transmission groups, older, and housed persons. 12–15,27 Although these subpopulations were not associated with delayed or no ART initiation in our secondary analysis, others have shown that they have lower rates of retention in care and thus adherence to ART, 28–30 which is likely a contributing factor for our findings. Furthermore, although the number of new HIV diagnoses decreased in recent years, including among vulnerable subpopulations, some groups such as PWID saw smaller decreases in new diagnoses over time compared with MSM.…”

“…We also found that less time spent above 10,000 copies per milliliter was associated with Asian/Pacific Islander race compared with whites, although in our secondary multivariate analysis, Asian/Pacific Islanders were not less likely than whites to have delayed or no ART initiation. We could not compare this finding with other similar studies because Asians and Pacific Islanders were included with other races, 12–14,16 but in 1 of these studies, persons of “other race,” which likely would have included Asians and Pacific Islanders, were associated with less time viremic. 16 Furthermore, we found Latinos were less likely to have delayed or no ART initiation but were not associated with less time spent above the viral thresholds compared with whites.…”

“…The percent time above these thresholds in our population is higher than some other studies of persons in care, although these studies were conducted before 2016, making direct comparison difficult. 12–16…”

“…Using this new methodology, several studies among persons receiving HIV care documented sustained cumulative viral loads greater than 200, 1,500, and 10,000 copies per milliliter, demonstrating substantial HIV transmission potential. 12–16 In a previous study of adults receiving HIV care in San Francisco from 2012 through 2014, we found that this population spent 12% of the time unsuppressed (viral load >200 copies/mL) and 7% transmissible (viral load >1500 copies/mL). 14 Given that HIV transmission and virologic failure risk has been found to be greatest in the first 6–12 months after early initiation of ART, we expanded on our previous study to measure time spent unsuppressed and time spent transmissible among persons newly diagnosed with HIV in San Francisco, including after the implementation of the RAPID initiative.…”

“…Using previously described methods, [12][13][14] consecutive viral load pairs were used to calculate percent of person-time (pPT) spent above 200 copies per milliliter (pPT .200), 1500 copies per milliliter (pPT .1500), and 10,000 copies per milliliter (pPT .10,000) during the 12 months after HIV diagnosis. Viral load values from the date of diagnosis to 365 days later were used to calculate viral outcome measures.…”