Gaps Up to 9 Months between HIV Primary Care Visits Do Not Worsen Viral Load

Lytt I. Gardner, Gary Marks, Unnati Patel, Edward Cachay, Tracey E. Wilson, Michael Stirratt, Allan Rodriguez, Meg Sullivan, Jeanne C. Keruly, Thomas P. Giordano

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Current guidelines specify that visit intervals with viral monitoring should not exceed 6 months for HIV patients. Yet, gaps in care exceeding 6 months are common. In an observational cohort using US patients, we examined the association between gap length and changes in viral load status and sought to determine the length of the gap at which significant increases in viral load occur. We identified patients with gaps in care greater than 6 months from 6399 patients from six US HIV clinics. Gap strata were >6 to <7, 7 to <8, 8 to <9, 9 to <12, and ≥12 months, with viral load measurements matched to the opening and closing dates for the gaps. We examined visit gap lengths in association with two viral load measurements: continuous (log 10 viral load at gap opening and closing) and dichotomous (whether patients initially suppressed but lost viral suppression by close of the care gap). Viral load increases were nonsignificant or modest when gap length was <9 months, corresponding to 10% or fewer patients who lost viral suppression. For gaps ≥12 months, there was a significant increase in viral load as well as a much larger loss of viral suppression (in 23% of patients). Detrimental effects on viral load after a care gap were greater in young patients, black patients, and those without private health insurance. On average, shorter gaps in care were not detrimental to patient viral load status. HIV primary care visit intervals of 6 to 9 months for select patients may be appropriate.

Original languageEnglish (US)
Pages (from-to)157-164
Number of pages8
JournalAIDS patient care and STDs
Issue number4
StatePublished - Apr 2018


  • HIV
  • gaps in care
  • viral load
  • viral suppression

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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