Earlier HIV Care Linked to Faster Viral Suppression

An estimated 1.1 million people are HIV-infected in the United States and approximately 200,000 are unaware of their infection status and not receiving treatment.¹ Even among patients with diagnosed HIV infection, an estimated 20% do not receive medical care.² These numbers persist despite the fact that suppression of HIV viral load is proved to reduce HIV-related morbidity and mortality and can reduce transmission of the virus.³

A recent study published in the journal PLoS One,⁴ used data from the national HIV surveillance system to determine the association of care visits with time from diagnosis of HIV infection to viral suppression. Factors associated with viral suppression examined were early linkage to care, defined as having one or more CD4 or viral load tests within 3 months of diagnosis, and the number of care visits during the observation period (determined by results of CD4 and viral load tests).⁴ The study included data from 17,028 persons with HIV infection in 2009 and followed through December 2011 in 19 US jurisdictions. More than three-quarters of persons with HIV infection (76.6%) were linked to care within 3 months of diagnosis. The median time from diagnosis to viral suppression was 19 months overall. The time to viral suppression was shorter for patients who entered care within 3 months of diagnosis versus those who entered after 3 months. Patients with a higher number of early care visits also experienced a shorter time to viral suppression (HR = 1.51 for every additional visit [95% CI, 1.49-1.52]).⁴

This large population-based study, which uses national HIV surveillance data, provides empirical support for the importance of early linkage to care following an HIV diagnosis. It also demonstrates that more care visits early on after diagnosis are associated with a faster time to viral suppression.⁴   

Take-home message:

Physicians who see patients with newly diagnosed HIV infection should encourage timely linkage to care and emphasize the importance of early follow-up visits in achieving rapid viral suppression.

References:

• Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data-United States and 6 U.S. dependent areas–2010. HIV Surveillance Supplemental Report 17 (No. 3, part A). Available at: http://www.cdc.gov/hiv/topics/surveillan​ce/resources/reports. Accessed March 11, 2014.
• Hall HI, Gray Mahle K, Tang T, et al. Retention in care of adults and adolescents living with HIV in 13 U.S. areas. J Acquir Immune Defic Syndr. 2012;60:77–82. doi:10.1097/qai.0b013e318249fe90.
• Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493–505. doi:10.1056/NEJMoa1105243.
• Hall HI, Tang T, Westfall AO, Mugavero MJ. HIV care visits and time to viral suppression, 19 U.S. jurisdictions, and implications for treatment, prevention and the national HIV/AIDS strategy. PLoS One. 2013 Dec 31;8:e84318. doi:10.1371/journal.pone.0084318.eCollection 2013.