The most common measure of viral suppression (VS) in clinical and surveillance studies is the most recent viral load (VL) < 200 copies/mL in past 12 months. This single-value measure does not capture the VL dynamics over time. We examined durable VS, never virally suppressed, and change in VS status to offer new types of metrics that help us better understand VS patterns.
We used data from the National HIV Surveillance System reported from 33 jurisdictions among persons aged ≥ 13 years with HIV infection diagnosed by year-end 2013 and alive at year-end 2014. We calculated the percentage of HIV-diagnosed persons whose last VL was <200 copies/mL in 2014 and the percentage of HIV-diagnosed persons who had durable VS (all VLs < 200 copies/mL) in 2014. Among persons who had at least 2 VLs in 2014 (indication of being in HIV care), we calculated the percentage of persons never virally suppressed (all VLs > 200 copies/mL) and created 4 groups based on the first and last VLs in 2014: both suppressed, first unsuppressed and last suppressed (improved), first suppressed and last unsuppressed (worsen), and both unsuppressed.
Of 630,965 persons with diagnosed HIV, 361,665 (57.3%) had the last VL suppressed and 316,442 (50.2%) had durable VS in 2014 (relative difference: 14.3%). Among 339,515 persons in HIV care, 28,782 (8.5%) persons never had suppressed VLs in 2014. The breakdown of change in VS status indicates that 75.4% had first and last VL suppressed, 10.5% improved, 4.2% worsened, and 9.9% had first and last unsuppressed. The percent ‘never suppressed’ was higher among females than males (11.1% vs. 7.7%). Among race/ethnic groups, blacks/African Americans had the highest percentage of persons in HIV care never virally suppressed (see Table). This racial/ethnic disparity was observed in men who have sex with men (MSM), injection drug use (IDU) for both sexes, MSM/IDU, heterosexual contact for both sexes, and other transmission category.
Using single VL measures overestimated by 14.3% relative difference of HIV-diagnosed persons with durable VS. Half of HIV-diagnosed persons had durable VS in 2014. Among patients in HIV care, more showed improving than worsening VS status, yet 8.5% never had a suppressed VL within a 12-month period and racial/ethnic disparities were observed in this outcome. Targeted clinical interventions are needed to help patients achieve and maintain durable VS.