In the Journals

23-year study shows treatment barriers faced by some women with HIV

Findings from a 23-year study of HIV-positive women in the United States demonstrated that although most achieved viral suppression, many others face circumstances that make successful treatment difficult, including mental health, social, behavioral and structural factors, researchers reported.

“Survival is a priority over putting a pill in your mouth for a number of our participants, and that is the public health challenge we must address,” Seble G. Kassaye, MD, MS, associate professor of medicine and infectious diseases at Georgetown University, said in a news release.

Prompted by “evolving treatment guidelines, variations in viral suppression, and increased policy focus on achieving viral suppression,” Kassaye and colleagues conducted an initial study that examined longitudinal viral suppression in women enrolled in the Washington, D.C. Women’s Interagency HIV Study. They identified three distinct longitudinal viremia trajectory patterns: high, intermediate or low probability of viral suppression.

However, participants were limited to the Mid-Atlantic. To characterize longitudinal HIV viral load outcomes in a larger cohort, they expanded the study to include women enrolled at Women’s Interagency HIV Study sites in Chicago, San Francisco, Washington, D.C. and two New York City boroughs, the Bronx and Brooklyn.

The published analysis included 1,989 HIV-positive women who were enrolled in three waves in 1994-1995, 2000-2001 and 2010-2013. The women underwent semiannual study visits and a minimum of five follow-up visits between 1994 and 2017. The mean age of participants at baseline was 36.9 years, the mean CD4+ T-lymphocyte count was 467/mm3 and the median HIV RNA was 6,200 copies/mL. African Americans comprised 65.6% of all study participants.

Kassaye and colleagues categorized the women based on their probability of achieving viral load suppression. According to the study, 28.6% of participants had a low probability of viremia, 39.4% had an intermediate probability and 32% had a high probability. The mean cumulative years of viral suppression were 18.7 years, 12.2 years and 5.8 years, respectively, among the three groups.

The researchers found that younger age (OR = 0.99; 95% CI, 0.98-0.99), African American race (OR = 2.43; 95% CI, 1.75-3.37), Hispanic race/ethnicity (OR = 1.50; 95% CI, 1.03-2.19), increased levels of depressive symptoms (OR = 1.17; 95% CI, 1.01-1.36), drug use (OR = 1.23; 95% CI, 1.01-1.51), lower CD4+ T-lymphocyte counts (OR = 95% CI, 0.82; 0.80-0.85) and unstable housing (OR = 1.25, 95% CI, 1.03-1.50) were associated with a high probability of viremia.

In all, 71.2% of women achieved sustained viral suppression between 2015 and 2017, including 89.6% who were categorized as having a low probability of viremia, 83.4% in the intermediate group and 35.2% classified as having a high probability of viremia.

“So, the rosy picture is that 71% of the women achieved viral suppression, but the granular detail tells us that some women are doing very well, with 89.6% of the women in the low probability of viremia consistently suppressed in the recent years, but others are still struggling to get to viral suppression,” Kassaye said. – by Marley Ghizzone

Disclosures: Kassaye reports receiving grants from the NIH. Please see the study for all other authors’ relevant financial disclosures.

Findings from a 23-year study of HIV-positive women in the United States demonstrated that although most achieved viral suppression, many others face circumstances that make successful treatment difficult, including mental health, social, behavioral and structural factors, researchers reported.

“Survival is a priority over putting a pill in your mouth for a number of our participants, and that is the public health challenge we must address,” Seble G. Kassaye, MD, MS, associate professor of medicine and infectious diseases at Georgetown University, said in a news release.

Prompted by “evolving treatment guidelines, variations in viral suppression, and increased policy focus on achieving viral suppression,” Kassaye and colleagues conducted an initial study that examined longitudinal viral suppression in women enrolled in the Washington, D.C. Women’s Interagency HIV Study. They identified three distinct longitudinal viremia trajectory patterns: high, intermediate or low probability of viral suppression.

However, participants were limited to the Mid-Atlantic. To characterize longitudinal HIV viral load outcomes in a larger cohort, they expanded the study to include women enrolled at Women’s Interagency HIV Study sites in Chicago, San Francisco, Washington, D.C. and two New York City boroughs, the Bronx and Brooklyn.

The published analysis included 1,989 HIV-positive women who were enrolled in three waves in 1994-1995, 2000-2001 and 2010-2013. The women underwent semiannual study visits and a minimum of five follow-up visits between 1994 and 2017. The mean age of participants at baseline was 36.9 years, the mean CD4+ T-lymphocyte count was 467/mm3 and the median HIV RNA was 6,200 copies/mL. African Americans comprised 65.6% of all study participants.

Kassaye and colleagues categorized the women based on their probability of achieving viral load suppression. According to the study, 28.6% of participants had a low probability of viremia, 39.4% had an intermediate probability and 32% had a high probability. The mean cumulative years of viral suppression were 18.7 years, 12.2 years and 5.8 years, respectively, among the three groups.

The researchers found that younger age (OR = 0.99; 95% CI, 0.98-0.99), African American race (OR = 2.43; 95% CI, 1.75-3.37), Hispanic race/ethnicity (OR = 1.50; 95% CI, 1.03-2.19), increased levels of depressive symptoms (OR = 1.17; 95% CI, 1.01-1.36), drug use (OR = 1.23; 95% CI, 1.01-1.51), lower CD4+ T-lymphocyte counts (OR = 95% CI, 0.82; 0.80-0.85) and unstable housing (OR = 1.25, 95% CI, 1.03-1.50) were associated with a high probability of viremia.

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In all, 71.2% of women achieved sustained viral suppression between 2015 and 2017, including 89.6% who were categorized as having a low probability of viremia, 83.4% in the intermediate group and 35.2% classified as having a high probability of viremia.

“So, the rosy picture is that 71% of the women achieved viral suppression, but the granular detail tells us that some women are doing very well, with 89.6% of the women in the low probability of viremia consistently suppressed in the recent years, but others are still struggling to get to viral suppression,” Kassaye said. – by Marley Ghizzone

Disclosures: Kassaye reports receiving grants from the NIH. Please see the study for all other authors’ relevant financial disclosures.