Identification of facilitators and barriers to the achievement and maintenance of suppression of HIV requires an understanding and appreciation of long-term individual-level HIV care and treatment dynamics. We aimed to identifying these distinct patterns via the concept of HIV treatment careers (dynamic developmental trajectories that people living with HIV experience throughout a lifetime). For this project, we have used methods using the probability of viral suppression patterns among an observational cohort of women enrolled and followed within the Metropolitan District of Columbia, Women’s Interagency HIV Study (DC-WIHS) from 1994 - 2012. Understanding both positive and negative influences of HIV treatment career for individuals living with HIV can help improve health outcomes and mitigate ongoing HIV transmission.
We analyzed data from women enrolled in the DC-WIHS with >4 semiannual visits using a group-based logistic trajectory analysis approach to identify patterns of viral suppression < 80 c/mL and explored group characteristics using generalized linear modeling with generalized estimating equations for repeated measures.
329 women contributed 6633 visits between 1995-2012 and demonstrated trajectory patterns with high, moderate and low probabilities of remaining viremic in 40.7%, 35.6%, and 23.7% of participant-visits, respectively (Fig. 1). In the multivariate analyses, African American (OR 2.15, p=0.0169), older age (OR 1.03, p=0.0058), depression (OR 1.38, p=0.0299), and no therapy (OR 3.53, p< .0001) were positively associated with sustained viremia, while higher CD4+ T-cell count (OR 0.87, p< 0.0001), higher education (OR 0.58, p=0.0294) and higher adherence (OR 0.67, p=0.0037) were negatively associated with sustained viremia. Results were verified using cumulative viral suppression-years as the outcome (Fig. 2).
This longitudinal treatment cascade demonstrated three HIV-treatment careers using probability trajectories of viral suppression, and demonstrated low rates of viral suppression, and a large group of women with intermittent viremia at risk for transmitting drug-resistant HIV. These findings are problematic when observed in a research-primed cohort with access to HIV-outreach. We will explore factors underlying these different treatment careers using life course interviews and focus groups
- Mary Young
- Seble Kassaye
- Michael Plankey
- Chenglong Liu
- Cuiwei Wang
- Joanne Michelle Ocampo
- Jeff Collmann
- Joshua Ripple
- Georgetown University Medical Center (GUMC)
- National Institutes of Health (NIH)
- Women's Interagency HIV Study (WIHS)