Status disclosure patterns related to HIV care retention, viral load
SEATTLE — Identifying patient disclosure patterns may help predict retention in care and viral load suppression, according to data presented at CROI 2015.
“Knowledge that life expectancy and prevention of transmission to others is associated with adherence to antiretroviral therapy suggests that better understanding of barriers to retention in care and effective viral load suppression is a priority,” the researchers wrote in the abstract. “For newly diagnosed persons, the decision of whether and whom to disclose to is complex, with benefits weighed against perceived risks.”
Latesha E. Elopre, MD, of the University of Alabama at Birmingham, and colleagues examined the relationship between status disclosure, care retention and viral suppression in 508 patients with HIV from 2007-2013. Participants were aged 19 years or older and had never received HIV care. Sixty-one percent were black and 82% were men, of which 60% were men who have sex with men. Poor retention was defined as a gap in care greater than 180 days, and viral load suppression as a viral load less than 200 copies/mL as measured 12 months after initiating HIV care. Primary univariate and multivariable analyses compared patients who did or did not disclose their HIV status. Secondary analysis examined patients who either did not disclose or disclosed only to a single party versus those who shared their status with two or more parties.
Latesha E. Elopre
Thirteen percent of participants reported nondisclosure and 51% reported disclosure limited to a single party. In primary multivariable analysis, nondisclosure was associated with poor retention (adjusted OR = 2.3; 95% CI, 1.3-4.1), but not with higher viral loads. A secondary multivariable analysis saw a similar association between nondisclosure and retention (aOR = 2.2; 95% CI, 1.2-4.3), as well as a greater frequency of viremia in those who disclosed status only to friends (aOR = 2.6; 95% CI, 1.0-6.5) or family (aOR = 2.9; 95% CI, 1.2-7.6).
“What we think is going on is that people who have only disclosed to their family did so due to disease progression,” Elopre told Infectious Disease News. “Maybe they can’t really hide it anymore, or maybe the support they got after disclosing to their family wasn’t the best. We don’t know, so we’re hoping to do a further analysis looking at this interesting population.”– by Dave Muoio
Elopre LE, et al. Abstract 1004. The Role of HIV Status Disclosure in Retention in Care and Viral-Load Suppression. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 23-26, 2015; Seattle.