What the Results Mean for You
The key message of this large and thorough CDC study is that HIV-positive people who keep regular appointments with their providers are more likely to have an undetectable viral load than people who do not keep as many appointments.
This finding is not surprising. People who keep more appointments are often more concerned about their health and more organized, so they are more likely to start antiretroviral therapy and to take their antiretrovirals regularly -- giving them the best chance to reach an undetectable viral load. Also, people who keep more clinic appointments get more support from their provider and other health professionals, who can help solve problems and relieve side effects that may arise during therapy.
What is surprising about this study is the big gap between rates of undetectable viral load in people retained in care by either study definition (74% or 78%) and the rate in people only engaged in care (48%). Reaching an undetectable viral load should be the main goal of everyone with HIV infection -- because it will improve their own health and lower their chance of passing HIV to a sex partner. When only half of any HIV group has an undetectable viral load, the other half still has lots of work to do.
Just as striking was the finding that only two thirds of people diagnosed with HIV in these 18 states and Washington, DC had evidence of any HIV care (a CD4 count or viral load test) in 2010. The CDC investigators stress that this proportion of people in care "is far too low."
The researchers also underline the findings that younger people (13 to 34 years old) and blacks had particularly low rates of achieving an undetectable viral load. Compared with people 55 or older, 13-to-24-year-olds had a 64% lower undetectable viral load rate, and 25-to-34-year-olds had a 40% lower rate. Compared with whites, blacks had a 37% lower undetectable viral load rate. These findings emphasize the need for all HIV-positive people -- young and old, whatever their ethnic origin -- to get care, to keep clinic appointments, and to start and stick with antiretroviral therapy.
Results of this large study reflect recent findings in another CDC analysis. This previous study determined that starting care within 3 months of HIV diagnosis and making more clinic visits resulted in a faster time to reaching an undetectable viral load.3 The study reviewed just before this one in HIV Treatment Alerts linked missing three or more HIV clinic appointments to more than a tripled the risk of death from any cause.4
An important limitation of the new study is that the CDC researchers did not have information on how many people were taking antiretroviral therapy or how faithfully they took their pills. So they could not consider the impact of pill-taking habits on how many people reached an undetectable viral load. Once a person starts antiretroviral therapy, taking all pills regularly is essential to controlling HIV.
- Cohen SM, Hu X, Sweeney P, Johnson AS, Hall HI. HIV viral suppression among persons with varying levels of engagement in HIV medical care, 19 US jurisdictions. J Acquir Immune Defic Syndr. 2014;67:519-527.
- Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data -- United States and 6 dependent areas -- 2011. HIV Surveill Supplemental Rep. 2013;18.
- Hall HI, Tang T, Westfall AO, et al. HIV care visits and time to viral suppression, 19 U.S. jurisdictions, and implications for treatment, prevention, and the National HIV/AIDS Strategy. PLoS One. 2013;8:e84318.
- Mugavero MJ, Westfall AO, Cole SR, et al. Beyond core indicators of retention in HIV care: missed clinic visits are independently associated with all-cause mortality. Clin Infect Dis. 2014;59:1471-1479.