Viral suppression is associated with reduced morbidity, mortality, and risk of transmitting HIV. Estimating the percentage of persons with HIV who have durably suppressed viral loads (DSVL), plasma HIV burden, and time without viral load (VL) suppression can help in monitoring disease burden and HIV transmission risk potential and guide interventions.
We used data from the National HIV Surveillance System reported from 17 jurisdictions to determine viral burden among persons aged > 13 years who received a diagnosis of HIV infection before 2011 and were alive through 2013. DSVL was defined as all viral loads < 200 copies/mL during 2012-2013. Viremia copy-years were estimated to determine plasma HIV burden. HIV transmission risk potential was estimated by time viral load was above 200 copies/mL over the 2-year period.
Of 264,865 persons engaged in care (with at least 1 VL) in 2011, 251,649 (95%) had VL tests between 2012 and 2013. The median number of VL tests during the 2-year period was 5. Of the 251,649 persons, 62% had DSVL. The percentages of persons with DSVL were lower among females (vs. males: 55% & 64%), black/African American (vs. white: 53% & 74%), and persons aged 13-24 years old (vs. > 55 years: 39% & 73%). The geometric mean viremia copy-years in the 2-year period among those without DSVL was higher than the geometric mean averaged across all persons (7,730 vs. 356 copies/mL). Among those without DSVL, the average number of days a person spent above 200 copies/mL was 452 days, corresponding to 62% of the 2-year observation time. Among those without DSVL, female, black/African American, and persons aged 13-24 also had substantially higher geometric means of viremia copy-years and higher numbers of days with VL above 200 copies/mL compared to their respective counterparts (female vs. male: 8,360 & 7,494 copy-years; 478 & 442 days; black/African American vs. white: 9,341 & 5,851 copy-years; 483 & 412 days; aged 13-24 vs. >55 years: 13,971 vs. 3,356 copy-years; 550 & 377 days).
It is encouraging that about two-thirds of HIV-diagnosed persons in care had suppressed VL over a 2-year period. The remaining one-third had high plasma burden and spent substantial time without VL suppression, which increases the risk of HIV transmission. Greater disparities in disease burden and transmission risk potential were seen in several subgroups. Targeted care and treatment efforts are needed to address the disparities.