Using Monitored Viral Load as a Measure of Health Outcomes Among Kentuckians Living with HIV Disease

BACKGROUND: Monitored viral load (MVL) is a population-level marker of HIV transmission risk but can also be used as an indicator of health outcomes for a population. Kentucky used MVL markers as a broad indicator of health outcomes among the group of persons living with HIV disease. 

METHODS:   The Kentucky Department for Public Health (KDPH) used MVL markers of viral suppression and detection to measure health outcomes. Kentuckians diagnosed with HIV disease by the end of 2009 and living through December 31, 2010 were included in this cross-sectional analysis. The most recent virologic laboratory result collected in 2010 and reported in the enhanced HIV/AIDS Registry System (eHARS) by December 31, 2012 was used to measure health outcomes. 

RESULTS:   Of the 4,773 Kentuckians living with HIV at the end of 2009, about half had at least one virologic result reported to KDPH. Based on the most recent viral load result collected in 2010, 27% of Kentuckians had undetectable viral loads (<=50 copies/ml) while 32% achieved viral suppression (<=200 copies/ml). Data by demographics show slightly higher percentages of whites both virally undetected and suppressed (33% and 39% respectively) in comparison to blacks (16% and 21% respectively) and Hispanics (23% and 27% respectively). Males had slightly higher percentages of persons virally undetected and suppressed (27% and 33% respectively) compared to females (23% and 29% respectively). Undetectable viral load distribution and viral suppression by behavioral characteristics were both slightly higher among men who have sex with men (31% and 36 % respectively) and persons who had heterosexual contact (28% and 34% respectively) in comparison to other behavioral groups.

CONCLUSIONS:   Only nearly half of Kentuckians with HIV were reported as having a viral load collected in 2010. Although viral loads varied somewhat by race/ethnicity and gender, across all demographic and behavioral groups, 32% or less of Kentuckians attained undetectable viral loads or viral suppression in 2010. A low prevalence of persons whose viral loads are well managed has both personal and public health implications including increased morbidity, premature mortality and higher probabilities of transmission to partners. In order to achieve optimal health outcomes and also reduce the likelihood of HIV transmission risk, KDPH and care providers need to focus on increasing the percentage of Kentuckians receiving a viral load test as recommended every 3-6 months by the Department for Health and Human Services as an initial step in monitoring and managing levels of HIV viremia.