What we talk about when we talk about durable viral suppression

Diepstra, Karen L.; Lu, Haidong; McManus, Kathleen A; McQuade, Elizabeth T Rogawski; Rhodes, Anne; Westreich, Daniel

doi:10.1097/qad.0000000000002612

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…First, we focused on DVS instead of one-time achievement unlike prior studies [28,42]. This is important, as benefits are only achieved if suppression is durable [28], and it is known that suppression is not always sustained [42]. Although the DVS achievement in our sample seems high, this number is comparable to 90% DVS rate reported by Ryan White Clinics, which primarily serve un/under-insured PWH [45].…”

Section: Discussionmentioning

confidence: 90%

“…Our work extends the literature in two ways. First, we focused on DVS instead of one-time achievement unlike prior studies [28,42]. This is important, as benefits are only achieved if suppression is durable [28], and it is known that suppression is not always sustained [42].…”

Section: Discussionmentioning

confidence: 99%

“…Our main outcome of interest was achievement of DVS during observation. DVS can be measured deterministically or through modelling [25][26][27][28]. A deterministic approach (e.g.…”

Section: Durable Viral Suppressionmentioning

confidence: 99%

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Intersectionality-informed analysis of durable viral suppression disparities in people with HIV

Rivera

Rusie

Feinstein³

et al. 2023

Aids

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Objective:The aim of this study was to examine drivers of durable viral suppression (DVS) disparities among people with HIV (PWH) using quantitative intersectional approaches.Design:A retrospective cohort analysis from electronic health records informed by intersectionality to better capture the concept of interlocking and interacting systems of oppression.Methods:We analyzed data of PWH seen at a LGBTQ federally qualified health center in Chicago (2012–2019) with at least three viral loads. We identified PWH who achieved DVS using latent trajectory analysis and examined disparities using three intersectional approaches: Adding interactions, latent class analysis (LCA), and qualitative comparative analysis (QCA). Findings were compared with main effects only regression.Results:Among 5967 PWH, 90% showed viral trajectories consistent with DVS. Main effects regression showed that substance use [odds ratio (OR) 0.56, 0.46–0.68] and socioeconomic status like being unhoused (OR: 0.39, 0.29–0.53), but not sexual orientation or gender identity (SOGI) were associated with DVS. Adding interactions, we found that race and ethnicity modified the association between insurance and DVS (P for interaction <0.05). With LCA, we uncovered four social position categories influenced by SOGI with varying rates of DVS. For example, the transgender women-majority class had worse DVS rates versus the class of mostly nonpoor white cisgender gay men (82 vs. 95%). QCA showed that combinations, rather than single factors alone, were important for achieving DVS. Combinations vary with marginalized populations (e.g. black gay/lesbian transgender women) having distinct sufficient combinations compared with historically privileged groups (e.g. white cisgender gay men).Conclusion:Social factors likely interact to produce DVS disparities. Intersectionality-informed analysis uncover nuance that can inform solutions.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Intersectionality-informed analysis of durable viral suppression disparities in people with HIV

Rivera

Rusie

Feinstein³

et al. 2023

Aids

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“…Second, while most published randomized trials used the definition of virologic suppression as HIV RNA viral load less than 50 copies/ml, we chose to use the threshold of HIV RNA less than 200 copies/ml as there was a portion of cohorts during this study period that had HIV viral load measurement with lower limit of detect greater than 50 copies/ml during 2009-2016. Future research could also focus on durable viral suppression (defined as consistent viral suppression for at least 12 months prior) if viral loads are measured more frequently [30]. Third, potential selection bias may exist as we did not account for death that occurred after the last measurement of viral load.…”

Section: Discussionmentioning

confidence: 99%

Virologic outcomes among adults with HIV using integrase inhibitor-based antiretroviral therapy

Cole²,

Westreich³

et al. 2021

Aids

Self Cite

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Background: Integrase strand transfer inhibitor (InSTI)-based regimens have been recommended as first-line antiretroviral therapy (ART) for adults with HIV. But data on long-term effects of InSTI-based regimens on virologic outcomes remain limited. Here we examined whether InSTI improved long-term virologic outcomes compared with efavirenz (EFV).Methods: We included adults from the North American AIDS Cohort Collaboration on Research and Design who initiated their first ART regimen containing either InSTI or EFV between 2009 and 2016. We estimated differences in the proportion virologically suppressed up to 7 years of follow-up in observational intention-to-treat and per-protocol analyses.Results: Of 15 318 participants, 5519 (36%) initiated an InSTI-based regimen and 9799 (64%) initiated the EFV-based regimen. In observational intention-to-treat analysis, 81.3% of patients in the InSTI group and 67.3% in the EFV group experienced virologic suppression at 3 months after ART initiation, corresponding to a difference of 14.0% (95% CI 12.4-15.6). At 1 year after ART initiation, the proportion virologically suppressed was 89.5% in the InSTI group and 90.2% in the EFV group, corresponding to a difference of À0.7% (95% CI À2.1 to 0.8). At 7 years, the proportion virologically suppressed was 94.5% in the InSTI group and 92.5% in the EFV group, corresponding to a difference of 2.0% (95% CI À7.3 to 11.3). The observational per-protocol results were similar to intention-to-treat analyses.

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“…Young people, especially women and key populations, continue to have a disproportionately low level of viral suppression 4. One goal of HIV care and treatment is achieving an undetectable viral load as it confers benefits at both the individual and public health level 8 9. There is strong evidence that supports that PLHIV cannot sexually transmit HIV to others when their viral load is suppressed to 200 HIV RNA copies/mL or lower, and they have been adherent to ART for at least 6 months 8 10–12…”

Section: Introductionmentioning

confidence: 99%

‘ARVs are a constant reminder of lost freedom, whereas for others, they are liberating’: understanding the treatment narrative among people living with HIV (PLHIV) in Malawi and Zimbabwe–a qualitative study

Gumede-Moyo,

Sharma,

Gwanzura

et al. 2024

BMJ Open

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ObjectiveThe aim of the research was to understand what drives and motivates young women living with HIV in their treatment journeys, as well as their key influencers. The findings will assist in appreciating their obstacles to treatment and constructing the most effective ways to convey fresh messages to them. These insights will contribute to the messaging developed for a campaign across sub-Saharan Africa, primarily Malawi and Zimbabwe.DesignThis was a qualitative study conducted in order to build an understanding of unknown parts of the HIV treatment journey through in-depth interviews. A hybrid approach was used to conduct thematic analysis.Setting and participantsStudy participants were HIV-positive women, their influencers (eg, parents/partners/siblings/aunts and uncles/religious leaders, etc) and healthcare providers from a range of regions in Zimbabwe and Malawi.ResultsA total of 26 young people living with HIV (PLHIV), 29 healthcare providers and 24 influencers such as maternal figures in the community were interviewed. Two main broad insights were drawn, that is, key needs and wider contextual factors. The key needs of young PLHIV to stay on treatment were empathy, support and emotional connection with antiretroviral therapy (ART), while the wider contextual factors impacting their treatment journeys were structural challenges and cultural reference points. Fear of shame and humiliation can also be significant barriers to disclosure and treatment. The fear predisposes the PLHIV to the need for empathy, support and connection with ART. Mental health and anxiety appear to be comorbid with HIV. Some PLHIV have a small and limited support network leading to very few people living openly with HIV. There is no ‘one-size-fits-all’ approach, and maximising campaign reach will likely need a multifaceted approach.ConclusionCurrently, the relationship between nurses and PLHIV can appear to be transactional. Through learning about the community (including PLHIV), there are more chances of communicating in a way that resonates.

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What we talk about when we talk about durable viral suppression

Cited by 6 publications

References 20 publications

Intersectionality-informed analysis of durable viral suppression disparities in people with HIV

Intersectionality-informed analysis of durable viral suppression disparities in people with HIV

Virologic outcomes among adults with HIV using integrase inhibitor-based antiretroviral therapy

‘ARVs are a constant reminder of lost freedom, whereas for others, they are liberating’: understanding the treatment narrative among people living with HIV (PLHIV) in Malawi and Zimbabwe–a qualitative study

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