Trends in ART Prescription and Viral Suppression Among HIV-Positive Young Adults in Care in the United States, 2009–2013

Abstract

Background Only 13% of HIV-positive young adults are estimated to be virally suppressed and, even among those receiving medical care, HIV-positive young adults are less likely than older adults to take antiretroviral therapy (ART), be adherent, and be virally suppressed. We sought to examine trends in treatment and health outcomes from 2009 to 2013 among HIV-positive young adults (ages 18–24) in care. Setting The Medical Monitoring Project (MMP) is a complex sample survey of HIV-infected adults receiving medical care in the United States. Methods We used weighted interview and medical record data collected 06/2009-05/2014 to estimate trends in the prevalence of ART prescription, adherence, side effects, single-tablet ART regimens, regular care utilization and viral suppression among young adults. Results From 2009 to 2013, there were significant increases in ART prescription (76% to 87%) and the proportion of young adults taking ART who reported taking single-tablet regimens (49% to 62%). There was no significant change in adherence, side effects, or regular care utilization. Although viral suppression at last test did not change (65% at both time periods), the proportion of young adults who were sustainably virally suppressed significantly increased (29% to 46%). Accounting for ART prescription and single-tablet regimens use attenuated the sustained viral suppression trend. Conclusions Although the level of viral suppression among young adults in care remains suboptimal, the observed increases in ART prescription and sustained viral suppression may be cause for optimism regarding efforts to improve outcomes for this vulnerable population.

Depression Prevalence, Antidepressant Treatment Status, and Association with Sustained HIV Viral Suppression Among Adults Living with HIV in Care in the United States, 2009–2014

“…This is encouraging with regards to HIV clinical outcomes, suggesting that for many, depression may not be a substantial barrier to ART adherence, but somewhat contradicts previously published reports. This finding may reflect changes over time in HIV pharmacotherapy, including development of single-tablet ART regimens, decreased pill burden, and increased tolerability [45][46][47], with simpler ART regimens facilitating improved ART adherence in persons dually diagnosed with HIV and depression.…”

Longitudinal virological outcomes and factors associated with virological failure in behaviorally HIV-infected young adults on combination antiretroviral treatment in the Netherlands, 2000 to 2015

“…In accordance with our results, this study reported on the increased proportion of sustained viral suppression in young adults over the years. [24] A recent longitudinal study with a median follow-up period of 2.1 years from the United States described VF in 29% in those previously achieved viral suppression. In line with our data, young adults in this study who entered care after the year 2012 showed significantly better outcomes with only 3% experiencing VF after start cART.…”

HIV viral load trajectories of women living with HIV in Metro Vancouver, Canada

“…37,38 Research into adolescent- and youth-specific HIV services in the Canadian context are required. Further, with evidence of improved adherence and VL suppression among young PLWH on single-tablet regimens in the United States, 39 efforts to simplify ART regimens, including the development of injectable long-acting ART, may help improve VL suppression for young PLWH. 39…”