Durable Viral Suppression and Transmission Risk Potential Among Persons With Diagnosed HIV Infection: United States, 2012–2013

Crepaz, Nicole; Tang, Tian; Marks, Gary; Mugavero, Michael J.; Espinoza, Lorena; Hall, H. Irene

doi:10.1093/cid/ciw418

Cited by 112 publications

(112 citation statements)

References 16 publications

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“…Using a single VL measurement may also overestimate durable viral suppression [37]. However, our definitions provide a snapshot of the continuum in 2013 that is simple to interpret and communicate to policy makers.…”

Section: Discussionmentioning

confidence: 99%

The Human Immunodeficiency Virus Continuum of Care in European Union Countries in 2013: Data and Challenges

Gourlay

Noori

Pharris

et al. 2017

Clinical Infectious Diseases

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Section: Discussionmentioning

confidence: 99%

The Human Immunodeficiency Virus Continuum of Care in European Union Countries in 2013: Data and Challenges

Gourlay

Noori

Pharris

et al. 2017

Clinical Infectious Diseases

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“…Suboptimal adherence and high rates of loss to follow-up continue to influence the overall effectiveness of ART. A recent analysis of rates of virological suppression in low- and middle-income settings found that when loss to follow-up was taken into consideration, only around 62% of patients starting ART were virologically suppressed four years after starting ART [17] and in the United States only two-thirds of people in HIV care had durable viral suppression during a two-year period [18]. …”

Section: Discussionmentioning

confidence: 99%

Beyond the 90‐90‐90: refocusing HIV prevention as part of the global HIV response

Baggaley

Dalal

Johnson

et al. 2016

Journal of the International AIDS Society

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IntroductionThe remarkable expansion in availability of antiretroviral therapy (ART) over the past two decades has transformed HIV infection into a manageable chronic condition. People with HIV infection now live long and healthy lives on treatment that is simpler, safer and cheaper. According to UNAIDS estimates, the global coverage of ART reached 46% in 2015, resulting in a 26% decrease in annual HIV-related deaths since 2010. Such success has positioned treatment access at the centre of the global HIV response as a way to prevent mortality, morbidity and HIV transmission through a “Treat All” approach. Continuing expansion of treatment is needed to further reduce HIV-related mortality. This progress with treatment, however, masks a stagnation in the estimated annual number of new HIV infections. Continuing levels of HIV incidence despite treatment scale-up stem from several factors, which should be addressed in order to prevent new infections and decrease the numbers of people requiring treatment in the future.DiscussionART can only reach those already diagnosed, and although it is unclear what proportion of new infections occur during acute and early infection prior to treatment initiation, phylogenetic studies suggest that it might be substantial. Thus, better testing approaches to reach the 40% of people with undiagnosed HIV infection as early as possible are critical. New approaches to reach men, young people and key populations, where HIV risk is highest and HIV prevention, testing and treatment coverage is lowest, are also needed. Overall coverage of effective prevention interventions remains low, enabling HIV transmission to occur, or time is required to show population-level effects. For example, the full impact of the medical male circumcision intervention will be seen once a larger proportion of men in age cohorts with high incidence are circumcised. Finally, strategically focused pre-exposure prophylaxis interventions have the potential to prevent HIV acquisition among populations at substantial risk, averting treatment costs in coming years.ConclusionsThe United Nations (UN) targets to end AIDS include the “90-90-90” targets for HIV diagnosis, treatment and viral suppression. While 90-90-90 has been widely emphasized and adopted by countries and international funders, the focus thus far has largely been on increasing access to ART – the second “90.” A similar emphasis on achieving UN HIV prevention targets and adequate funding for meeting these is essential, alongside treatment, in order to reduce population-level incidence and change the trajectory of the HIV epidemic over the long term.

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“…Previous studies have shown that viral suppression among US women tended to be lower than the overall national average and lower than the national target of 90% . However, to our knowledge, US HIV surveillance data have not previously been used to examine rural‐urban differences among women with HIV.…”

mentioning

confidence: 91%

HIV Diagnoses and Viral Suppression Among US Women in Rural and Nonrural Areas, 2010–2017

Nwangwu‐Ike

Saduvala

Watson

et al. 2019

The Journal of Rural Health

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Background Women in rural areas face challenges to HIV diagnosis and care, including limited access to testing and treatment facilities. Recent declines in HIV diagnosis rates among women in the United States are encouraging. However, few studies have addressed how HIV diagnosis and care differ by rurality. Methods We analyzed National HIV Surveillance System data for women aged ≥13 years with diagnosed HIV infection. We examined diagnoses in the United States during 2010–2017. Then, for women living with diagnosed HIV in 40 jurisdictions with complete laboratory reporting, we assessed viral suppression (viral load <200 copies/mL). Analyses were stratified by rural‐urban category: rural (population <50,000), metropolitan (population 50,000‐499,000), and metropolitan statistical areas (MSA, population ≥500,000). Results Among 64,004 women who received a diagnosis of HIV infection during 2010‐2017, 4.2% resided in a rural area, 15% resided in a metropolitan area, and 80% resided in an MSA. Rural women had the highest percentage of stage 3 infection (acquired immune deficiency syndrome) at diagnosis (rural 30%, metropolitan 27%, MSA 25%). Of 190,735 women living with diagnosed HIV, viral suppression was lower in rural areas (rural 55%, metropolitan 59%, MSA 58%). Conclusions During 2010‐2017, most HIV diagnoses occurred among women residing in nonrural areas. However, women in rural areas had slightly higher levels of late diagnosis and lower levels of viral suppression, which might have resulted from differences in access to testing and treatment services. Interventions are needed to increase HIV testing, care, and viral suppression among women in rural areas.

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Durable Viral Suppression and Transmission Risk Potential Among Persons With Diagnosed HIV Infection: United States, 2012–2013

Cited by 112 publications

References 16 publications

The Human Immunodeficiency Virus Continuum of Care in European Union Countries in 2013: Data and Challenges

The Human Immunodeficiency Virus Continuum of Care in European Union Countries in 2013: Data and Challenges

Beyond the 90‐90‐90: refocusing HIV prevention as part of the global HIV response

HIV Diagnoses and Viral Suppression Among US Women in Rural and Nonrural Areas, 2010–2017

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