Antiretroviral prescription rates rose from 89% in 2009 to 94% in 2013 among HIV-positive people in care in the United States, according to a nationwide study by the Centers for Disease Control and Prevention (CDC). Over those same years, the proportion of people in care with a viral load below 200 copies/mL climbed from 72% to 80%, [[according to the study http://journals.lww.com/aidsonline/Abstract/2016/08240/Increased_antiretroviral_therapy_prescription_and.13.aspx]].
In 2009, the U.S. Department of Health and Human Services (DHHS) began recommending antiretroviral therapy (ART) for everyone with a CD4 count below 500 cells/mm3. In 2012 the DHHS [[recommended ART https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-treatment-guidelines/0]] for everyone with HIV, regardless of CD4 count. CDC investigators conducted this analysis of data from the Medical Monitoring Project to determine whether rates of antiretroviral prescription and viral suppression (defined as a viral load below 200 copies/mL) changed in that period.
The Medical Monitoring Project is a nationally representative sample of adults in care for HIV. This analysis focused on trends recorded from 2009 through 2013. CDC investigators determined the percentage of persons prescribed ART, the percentage with viral suppression on the last viral load test and the percentage with viral suppression on all viral load tests during the past 12 months.
The ART prescription rate rose from 88.7% in 2009 to 94.1% in 2013 (P
< .01). Prescription rates rose in every group defined by sex, sexual orientation and race/ethnicity except for "other" race/ethnicity. The rate rose more in women than in men (10% versus 5%, P
< .01) and most in the youngest age group, 18 to 29 years (from 72.2% in 2009 to 89.3% in 2013, P
< .01). Over the study period, antiretroviral prescribing increased more in blacks (8%) and Hispanics (7%) than in whites (3%), improvements reflecting lower 2009 rates in blacks and Hispanics (86.0% and 89.2%) than in whites (92.2%). By 2013, 95.2% of whites and Hispanics had an antiretroviral prescription, compared with 92.9% of blacks (P
The overall viral suppression rate on the last viral load test climbed from 71.6% in 2009 to 80.1% in 2013 (P < .01). Increasing suppression rates held true for every demographic group analyzed. The suppression rate gain was greater for women than men (16% versus 10%), but by 2013, a significantly higher proportion of men than women had attained viral suppression (81.3% versus 76.5%, P < .01). The percentage increase was twice higher in blacks (18%) than whites (8%) or Hispanics (9%). But by 2013 blacks still lagged whites in viral suppression rate (75.5% versus 86.0%). Overall, the CDC figured that 30% of the increase in viral suppression rate could be attributed to increased ART prescription.
The overall sustained viral suppression rate (all viral loads <200 copies/mL in the past 12 months) climbed from 57.6% in 2009 to 68.0% in 2013 (P < .01). During the past 12 months, participants averaged 2.8 viral load tests. The sustained suppression rate rose 21% in women and 16% in men over the study period, leaving 2013 sustained suppression rates of 63.5% in women and 69.6% in men (P < .01). Sustained suppression rates rose most in the youngest age group, but by 2013 only 50.5% of 18- to 29-year-olds had sustained suppression compared with 73.9% of people 50 and older (P < .01). The sustained suppression rate rose more in blacks than Hispanics or whites from 2009 through 2013. But by 2013 blacks had a sustained suppression rate of only 61.0% versus 76.0% in whites (P < .01). The CDC calculated that increased antiretroviral prescribing accounted for 19% of the rising trend in sustained suppression.
The CDC suggests that "rapid accumulation of evidence supporting early initiation of ART" and more aggressive DHHS ART initiation guidelines may be the most important factors in improving prescription and suppression rates. Increased access to antiretrovirals, more convenient regimens and better adherence probably also played roles, the CDC adds. The authors stress, however, that a significant percentage of people prescribed ART still have a detectable viral load, a gap pointing to the need for "enhanced efforts from clinical care providers and supportive service organizations[.]"
Mark Mascolini writes about HIV infection.
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