Viremia Trajectories of HIV in HIV-Positive Women in the United States, 1994-2017

• Type of Material: Article
• Authors: Seble G. Kassaye, Georgetown University Medical Center; Cuiwei Wang, Georgetown University Medical Center; Joanne Michelle F. Ocampo, Georgetown University Medical Center; Tracey E. Wilson, State University of New York; Kathryn Anastos, Albert Einstein College of Medicine of Yeshiva University; Mardge Cohen, Cook County Bureau of Health Services; Ruth M. Greenblatt, University of California San Francisco; Margaret A. Fischl, University of Miami Leonard M. Miller School of Medicine; Igho Ofotokun, Emory University; Adaora Adimora, University of North Carolina at Chapel Hill; Mirjam-Colette Kempf, University of Alabama at Birmingham; Gerald B. Sharp, National Institute of Allergy and Infectious Diseases; Mary Young, Georgetown University Medical Center; Michael Plankey, Georgetown University Medical Center
• Language: English
• Date: 2019-05-03
• Publisher: JAMA Network
• Publication Version: Final Published Version
• Copyright Statement: 2019 Kassaye SG et al. JAMA Network Open.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1001/jamanetworkopen.2019.3822
• Title of Journal or Parent Work: JAMA Network Open
• ISSN: 2574-3805
• Volume: 2
• Issue: 5
• Start Page: e193822
• End Page: e193822
• Grant/Funding Information: Dr Kassaye has been funded in part with Federal funds (grant KL2TR000102, previously KL2RR031974) from the National Center for Research Resources, and the National Center for Advancing Translational Sciences, a trademark of the Department of Health and Human Services, part of the Roadmap Initiative, Re-engineering the Clinical Research Enterprise.; The Women’s Interagency HIV Study is funded primarily by the NIAID, with additional cofunding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute of Drug Abuse, and the National Institute of Mental Health.; Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research, the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Deafness and Other Communication Disorders, National Institute for Minority Health and Health Disparities, and the NIH Office of Research on Women's Health.; WIHS data collection is also supported by UL1-TR000004 (University of California at San Francisco Clinical and Translational Science Awards [CTSA]) and UL1-TR000454 (Atlanta CTSA).
• Keywords: longitudinal viral trajectories; women; viremia; HIV; viral suppression; depression; age; unstable housing; race/ethnicity; drug use
• Research Categories: Psychology, Social; Biology, Virology

Abstract

Importance: Viral suppression of HIV is an important treatment goal to decrease morbidity, mortality, and risk of transmission to others. Objective: To characterize longitudinal HIV viral load outcomes among women enrolled in the Women's Interagency HIV Study (WIHS). Design, Setting, and Participants: A prospective cohort study of HIV-positive women with semiannual study visits and a minimum of 5 follow-up visits was conducted from 1994 to 2017. The WIHS sites included in this analysis are in Brooklyn and Bronx, New York; Chicago, Illinois; San Francisco, California; and Washington, DC. Main Outcomes and Measures: Women were categorized into groups based on their probability of achieving viral load suppression below 200 copies/mL using logistic trajectory modeling. Multinomial regression analysis was used to identify factors associated with placement in the group with the highest probability of viremia. Results: At baseline, the mean (SD) age of the 1989 women was 36.9 (8.0) years, mean CD4+ T-lymphocyte count was 467/mm3, median (interquartile range) HIV RNA was 6200.0 (384.5-41 678.0) copies/mL, and 1305 women (65.6%) were African American. Three trajectory groups were identified with low (568 [28.6%]), intermediate (784 [39.4%]), and high (637 [32.0%]) probability of viremia above 200 copies/mL. The mean (SD) cumulative years of viral suppression were 18.7 (4.0) years, 12.2 (3.1) years, and 5.8 (2.9) years in the respective groups. Factors associated with high probability of viremia included younger age (odds ratio [OR]. 0.99; 95% CI, 0.98-0.99; P = .03), African American race (odds ratio [OR], 2.43; 95% CI, 1.75-3.37), P < .001), Hispanic race/ethnicity (OR, 1.50; 95% CI, 1.03-2.19; P = .04), increased levels of depressive symptoms (OR, 1.17; 95% CI, 1.01-1.36; P = .03), drug use (OR, 1.23; 95% CI, 1.01-1.51; P = .04), lower CD4+ T-lymphocyte counts (OR, 95% CI, 0.82; 0.80-0.85; P < .001), and unstable housing (OR, 1.25, 95% CI, 1.03-1.50; P = .02). Between 2015 and 2017, 71.2% of women demonstrated sustained viral suppression: 89.6% (310 of 346) of those with low viremia, 83.4% (346 of 415) with intermediate, and 35.2% (112 of 318) with high probability of viremia. Conclusions and Relevance: This longitudinal approach suggested that the probability of viremia decreased substantially over time for most participants, including among women with earlier histories of incomplete viral suppression. The findings from this study suggest that continued efforts are needed to address mental health, social, behavioral and structural factors that were identified as associated with high probability of HIV viremia over time.