PMID- 30140916
OWN - NLM
STAT- MEDLINE
DCOM- 20190826
LR  - 20220408
IS  - 1539-3704 (Electronic)
IS  - 0003-4819 (Print)
IS  - 0003-4819 (Linking)
VI  - 169
IP  - 6
DP  - 2018 Sep 18
TI  - HIV Viral Suppression Trends Over Time Among HIV-Infected Patients Receiving Care 
      in the United States, 1997 to 2015: A Cohort Study.
PG  - 376-384
LID - 10.7326/M17-2242 [doi]
AB  - BACKGROUND: Because HIV viral suppression is essential for optimal outcomes and 
      prevention efforts, understanding trends and predictors is imperative to inform 
      public health policy. OBJECTIVE: To evaluate viral suppression trends in people 
      living with HIV (PLWH), including the relationship of associated factors, such as 
      demographic characteristics and integrase strand transfer inhibitor (ISTI) use. 
      DESIGN: Longitudinal observational cohort study. SETTING: 8 HIV clinics across 
      the United States. PARTICIPANTS: PLWH receiving clinical care. MEASUREMENTS: To 
      understand trends in viral suppression (</=400 copies/mL), annual viral suppression 
      rates from 1997 to 2015 were determined. Analyses were repeated with tests 
      limited to 1 random test per person per year and using inverse probability of 
      censoring weights to address loss to follow-up. Joint longitudinal and survival 
      models and linear mixed models of PLWH receiving antiretroviral therapy (ART) 
      were used to examine associations between viral suppression or continuous viral 
      load (VL) levels and demographic factors, substance use, adherence, and ISTI use. 
      RESULTS: Viral suppression increased from 32% in 1997 to 86% in 2015 on the basis 
      of all tests among 31 930 PLWH. In adjusted analyses, being older (odds ratio 
      [OR], 0.76 per decade [95% CI, 0.74 to 0.78]) and using an ISTI-based regimen 
      (OR, 0.54 [CI, 0.51 to 0.57]) were associated with lower odds of having a 
      detectable VL, and black race was associated with higher odds (OR, 1.68 [CI, 1.57 
      to 1.80]) (P < 0.001 for each). Similar patterns were seen with continuous VL 
      levels; when analyses were limited to 2010 to 2015; and with adjustment for 
      adherence, substance use, or depression. LIMITATION: Results are limited to PLWH 
      receiving clinical care. CONCLUSION: HIV viral suppression rates have improved 
      dramatically across the United States, which is likely partially attributable to 
      improved ART, including ISTI-based regimens. However, disparities among younger 
      and black PLWH merit attention. PRIMARY FUNDING SOURCE: National Institutes of 
      Health.
FAU - Nance, Robin M
AU  - Nance RM
AD  - University of Washington, Seattle, Washington (R.M.N., J.C.D., J.M.S., B.M.W., 
      F.M.A., R.J.F., M.M.K., H.M.C.).
FAU - Delaney, J A Chris
AU  - Delaney JAC
AD  - University of Washington, Seattle, Washington (R.M.N., J.C.D., J.M.S., B.M.W., 
      F.M.A., R.J.F., M.M.K., H.M.C.).
FAU - Simoni, Jane M
AU  - Simoni JM
AD  - University of Washington, Seattle, Washington (R.M.N., J.C.D., J.M.S., B.M.W., 
      F.M.A., R.J.F., M.M.K., H.M.C.).
FAU - Wilson, Ira B
AU  - Wilson IB
AD  - Brown University, Providence, Rhode Island (I.B.W.).
FAU - Mayer, Kenneth H
AU  - Mayer KH
AD  - Harvard Medical School and Fenway Institute, Boston, Massachusetts (K.H.M.).
FAU - Whitney, Bridget M
AU  - Whitney BM
AD  - University of Washington, Seattle, Washington (R.M.N., J.C.D., J.M.S., B.M.W., 
      F.M.A., R.J.F., M.M.K., H.M.C.).
FAU - Aunon, Frances M
AU  - Aunon FM
AD  - University of Washington, Seattle, Washington (R.M.N., J.C.D., J.M.S., B.M.W., 
      F.M.A., R.J.F., M.M.K., H.M.C.).
FAU - Safren, Steven A
AU  - Safren SA
AD  - University of Miami, Miami, Florida, and Fenway Institute, Boston, Massachusetts 
      (S.A.S.).
FAU - Mugavero, Michael J
AU  - Mugavero MJ
AD  - University of Alabama at Birmingham, Birmingham, Alabama (M.J.M., M.S.S.).
FAU - Mathews, W Christopher
AU  - Mathews WC
AD  - University of California, San Diego, San Diego, California (W.C.M.).
FAU - Christopoulos, Katerina A
AU  - Christopoulos KA
AD  - University of California, San Francisco, San Francisco, California (K.A.C.).
FAU - Eron, Joseph J
AU  - Eron JJ
AD  - University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.J.E., 
      S.N.).
FAU - Napravnik, Sonia
AU  - Napravnik S
AD  - University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.J.E., 
      S.N.).
FAU - Moore, Richard D
AU  - Moore RD
AD  - Johns Hopkins University, Baltimore, Maryland (R.D.M., B.L.).
FAU - Rodriguez, Benigno
AU  - Rodriguez B
AD  - Case Western Reserve University, Cleveland, Ohio (B.R.).
FAU - Lau, Bryan
AU  - Lau B
AD  - Johns Hopkins University, Baltimore, Maryland (R.D.M., B.L.).
FAU - Fredericksen, Rob J
AU  - Fredericksen RJ
AD  - University of Washington, Seattle, Washington (R.M.N., J.C.D., J.M.S., B.M.W., 
      F.M.A., R.J.F., M.M.K., H.M.C.).
FAU - Saag, Michael S
AU  - Saag MS
AD  - University of Alabama at Birmingham, Birmingham, Alabama (M.J.M., M.S.S.).
FAU - Kitahata, Mari M
AU  - Kitahata MM
AD  - University of Washington, Seattle, Washington (R.M.N., J.C.D., J.M.S., B.M.W., 
      F.M.A., R.J.F., M.M.K., H.M.C.).
FAU - Crane, Heidi M
AU  - Crane HM
AD  - University of Washington, Seattle, Washington (R.M.N., J.C.D., J.M.S., B.M.W., 
      F.M.A., R.J.F., M.M.K., H.M.C.).
LA  - eng
GR  - P30 AI027767/AI/NIAID NIH HHS/United States
GR  - U01 AA020802/AA/NIAAA NIH HHS/United States
GR  - P30 AI094189/AI/NIAID NIH HHS/United States
GR  - U01 DA036935/DA/NIDA NIH HHS/United States
GR  - T32 AI007140/AI/NIAID NIH HHS/United States
GR  - R24 AI067039/AI/NIAID NIH HHS/United States
GR  - U24 AA020801/AA/NIAAA NIH HHS/United States
GR  - P30 AI027757/AI/NIAID NIH HHS/United States
GR  - P30 AI042853/AI/NIAID NIH HHS/United States
GR  - U01 AA020793/AA/NIAAA NIH HHS/United States
GR  - U54 GM115677/GM/NIGMS NIH HHS/United States
GR  - P30 AI050410/AI/NIAID NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
PT  - Research Support, N.I.H., Extramural
DEP - 20180821
PL  - United States
TA  - Ann Intern Med
JT  - Annals of internal medicine
JID - 0372351
RN  - 0 (Anti-HIV Agents)
RN  - 0 (HIV Integrase Inhibitors)
CIN - Ann Intern Med. 2018 Sep 18;169(6):411-412. PMID: 30140920
CIN - Ann Intern Med. 2019 Apr 16;170(8):582. PMID: 30986839
CIN - Ann Intern Med. 2019 Apr 16;170(8):582-583. PMID: 30986840
MH  - Adult
MH  - Age Factors
MH  - Anti-HIV Agents/*therapeutic use
MH  - Depression/complications
MH  - Female
MH  - HIV Infections/complications/*drug therapy/psychology/*virology
MH  - HIV Integrase Inhibitors/therapeutic use
MH  - Humans
MH  - Longitudinal Studies
MH  - Male
MH  - Medication Adherence
MH  - Middle Aged
MH  - Race Factors
MH  - Substance-Related Disorders/complications
MH  - United States
MH  - *Viral Load
PMC - PMC6388406
MID - NIHMS1005525
EDAT- 2018/08/25 06:00
MHDA- 2019/08/27 06:00
PMCR- 2019/03/18
CRDT- 2018/08/25 06:00
PHST- 2018/08/25 06:00 [pubmed]
PHST- 2019/08/27 06:00 [medline]
PHST- 2018/08/25 06:00 [entrez]
PHST- 2019/03/18 00:00 [pmc-release]
AID - 2697568 [pii]
AID - 10.7326/M17-2242 [doi]
PST - ppublish
SO  - Ann Intern Med. 2018 Sep 18;169(6):376-384. doi: 10.7326/M17-2242. Epub 2018 Aug 
      21.