AIDS research and human retroviruses 2017 05 02() doi 10.1089/AID.2017.0016
Longitudinal studies of retention in care (RIC) and viral suppression (VS) in the southeastern United States (US), a region disproportionately affected by HIV-infection, are lacking.
HIV-infected adults with ≥1 medical visit at the Vanderbilt Comprehensive Care Clinic (Nashville, Tennessee) from 2004-2013 were included. RIC was ≥2 (a) laboratory dates [CD4+ counts or HIV-1 viral loads (VL)] or (b) provider encounters and/or laboratory dates in the year of interest, ≥90 days apart. VS was a VL of <200 copies/mL at last measurement in the year of interest. Modified Poisson regression estimated relative risks (RR) of RIC and VS, adjusting for age, race, sex, HIV transmission risk, and socioeconomic status (SES). RESULTS
Among 4,641 persons, 76.8% achieved RIC and 70.2% achieved VS. RIC and VS increased from 2004 to 2013 (p<0.001 each). For lack of RIC, younger patients (RR=1.2 and RR=1.1, 18-24 and 25-34 vs. 35-44 year-olds, respectively), Blacks (RR=1.3 vs. Whites), and Injection Drug Users [IDU] (RR=1.2 vs. Heterosexual contact [Hetero]) fared worse (p<0.05 each); those with male-to-male sexual contact fared better (RR=0.8 vs. Hetero, p<0.05). For lack of VS, younger patients (RR=1.3 and RR=1.2, 18-24 and 25-34 vs. 35-44 year-olds, respectively), Blacks (RR 1.3 vs. Whites), Females (RR=1.1 vs. Males), IDUs (RR 1.3 vs. Hetero), and those with low SES (RR= 1.1 vs. not low SES) fared worse (p<0.05, each). CONCLUSIONS
RIC and VS increased over time, suggesting efforts to improve outcomes have been effective. However, disparities persist and resources should focus on groups most at risk.