Durable HIV Viral Load Suppression Among HIV-Positive People in Care in Washington State, 2009-2013

BACKGROUND:  The National HIV AIDS Strategy includes a goal of 80% of persons diagnosed and living with HIV (PLWH) in the U.S. achieving viral suppression by 2020. An HIV-positive individual’s viral load, however, can vary over time and be affected by a variety of factors. The purpose of this analysis was to describe factors associated with durable viral load suppression.

METHODS:  Weighted Washington State Medical Monitoring Project data from 2009-2013 were used for this analysis. Durable viral suppression meant all of a patient’s HIV viral load tests were less than or equal to 200 copies per ml of blood during the surveillance period (the 12 months prior to the patient interview). Significant associations were determined using Chi-square analysis and odds ratios.

RESULTS:  For the entire five-year period, 69% of patients (n=4,370) achieved durable viral load suppression during the surveillance period, while 31% (n=1,959) did not. The probability that any viral load in the past 12 months was above 200 copies/ml was influenced by the following significant relationships (odds ratio plus 95% CI):  1) Age:  18-24 years vs 55+:  OR = 6.10 (1.73-21.44); 25-34 vs. 55+:  OR = 3.19 (1.93-5.27); 35-44 vs 55+:  OR = 2.23 (1.51-3.29),  2) Time since HIV diagnosis:  diagnosed less than 5 years ago vs. diagnosed 10 or more years ago:  OR = 2.2 (1.48-3.28);  3) Frequency of HIV or CD4 tests in past year:  no HIV-related test vs. 3 or more tests:  OR = 172.4 (23.55->999.99);  4) Income: above poverty level vs. below:  OR = 0.60 (0.45-0.80);  5) Housing: not homeless vs. homeless:  OR = 0.34 (0.22-0.53);  6) Insurance: continuous insurance coverage vs. no insurance coverage:  OR = 0.47 (0.29-0.75);  7) Unmet need for services: no unmet need vs. any unmet need:  OR = 0.60 (0.46-0.79);  8) Depression: no depression vs. major or other depression:  OR = 0.69 (0.50-0.96);  9) Drug use: no drug use vs. injection or noninjection drug use:  OR = 0.49 (0.38-0.65);  10) Alcohol use: not a heavy drinker vs. a heavy drinker:  OR = 0.42 (0.24-0.74).

CONCLUSIONS:  For the years 2009 through 2013, significant associations with durable viral load suppression in PLWH in care in Washington were found by age, time since HIV diagnosis, number of HIV-related care visits, income, homelessness, insurance status, unmet need for services, depression, and drug and alcohol use. HIV case managers and healthcare practitioners should address these factors when they work with patients with unsuppressed viral loads.