TY - JOUR
T1 - High levels of antiretroviral use and viral suppression among persons in HIV care in the United States, 2010
AU - Dombrowski, Julia C.
AU - Kitahata, Mari M.
AU - Van Rompaey, Stephen E.
AU - Crane, Heidi M.
AU - Mugavero, Michael J.
AU - Eron, Joseph J.
AU - Boswell, Stephen L.
AU - Rodriguez, Benigno
AU - Mathews, W. Christopher
AU - Martin, Jeffrey N.
AU - Moore, Richard D.
AU - Golden, Matthew R.
PY - 2013/7/1
Y1 - 2013/7/1
N2 - Background: Contemporary data on patterns of antiretroviral therapy (ART) use in the United States are needed to inform efforts to improve the HIV care cascade. Methods: We conducted a cross-sectional study of patients in the Centers for AIDS Research Network of Integrated Clinical Systems cohort who were in HIV care in 2010 to assess ART use and outcomes, stratified by nadir CD4 count (≤350, 351-500, or >500 cells/mm3), demographics, psychiatric diagnoses, substance use, and engagement in continuous care (≥2 visits ≥3 months apart in 2010). Results: Of 8633 patients at 7 sites who had ≥1 medical visit and ≥1 viral load in 2010, 94% had ever initiated ART, 89% were on ART, and 70% had an undetectable viral load at the end of 2010. Fifty percent of ART-naive patients had nadir CD4 counts >500 cells per cubic millimeter, but this group comprised just 3% of the total population. Among patients who were ART naive at the time of cohort entry (N = 4637), both ART initiation and viral suppression were strongly associated with nadir CD4 count. Comparing 2009 and 2010, the percentages of patients with viral suppression among those with nadir CD4 counts 351-500 and >500 cells per cubic millimeter were 44% vs. 57% and 25% vs. 33%, respectively. Engagement in care was the only factor consistently associated with ART use and viral suppression across nadir CD4 count strata. Conclusions: Our findings suggest that ART use and viral suppression among persons in HIV care may be more common than estimated in some previous studies and increased from 2009 to 2010.
AB - Background: Contemporary data on patterns of antiretroviral therapy (ART) use in the United States are needed to inform efforts to improve the HIV care cascade. Methods: We conducted a cross-sectional study of patients in the Centers for AIDS Research Network of Integrated Clinical Systems cohort who were in HIV care in 2010 to assess ART use and outcomes, stratified by nadir CD4 count (≤350, 351-500, or >500 cells/mm3), demographics, psychiatric diagnoses, substance use, and engagement in continuous care (≥2 visits ≥3 months apart in 2010). Results: Of 8633 patients at 7 sites who had ≥1 medical visit and ≥1 viral load in 2010, 94% had ever initiated ART, 89% were on ART, and 70% had an undetectable viral load at the end of 2010. Fifty percent of ART-naive patients had nadir CD4 counts >500 cells per cubic millimeter, but this group comprised just 3% of the total population. Among patients who were ART naive at the time of cohort entry (N = 4637), both ART initiation and viral suppression were strongly associated with nadir CD4 count. Comparing 2009 and 2010, the percentages of patients with viral suppression among those with nadir CD4 counts 351-500 and >500 cells per cubic millimeter were 44% vs. 57% and 25% vs. 33%, respectively. Engagement in care was the only factor consistently associated with ART use and viral suppression across nadir CD4 count strata. Conclusions: Our findings suggest that ART use and viral suppression among persons in HIV care may be more common than estimated in some previous studies and increased from 2009 to 2010.
KW - Antiretroviral therapy
KW - HIV infections/drug therapy
KW - HIV infections/prevention & control
KW - Highly active
KW - Patient acceptance of health care/statistics and numerical data
KW - United States
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UR - http://www.scopus.com/inward/citedby.url?scp=84880207359&partnerID=8YFLogxK
U2 - 10.1097/QAI.0b013e3182945bc7
DO - 10.1097/QAI.0b013e3182945bc7
M3 - Article
C2 - 23572013
AN - SCOPUS:84880207359
SN - 1525-4135
VL - 63
SP - 299
EP - 306
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
IS - 3
ER -