Viral suppression rates in New York State: How good have we gotten?

Background: Advances in antiretroviral therapy (ART) have resulted in greater chances of viral suppression (VS) for patients. However, limited data exist on population rates of VS. NY State HIV/AIDS quality improvement program data were used to examine population rates of ART-related VS.

Methods: 101 NY HIV care centers submitted data on 5,417 patients seen in 2007. Eligible patients had ≥2 visits and viral loads (VL) in 2007 and were on ART in all trimesters seen. Outcomes included: VL≤50 and ≤400 on every VL (always suppressed, AVS) and on >1 VL (ever suppressed, EVS). VS disparities were examined using bivariate and multivariate logistic regression.

Results: 87% were EVS at ≤400 (56%, VL≤50) and 63% AVS at ≤400 (31%, VL≤50). Significantly (p<0.001) lower AVS rates (≤400) were found for younger patients, minorities, non- MSM risk, current substance users, patients less engaged in care, and patients with CD4 counts always ≤200. AVS≤50 showed similar results. While rates of EVS were higher than AVS, similar disparities were seen. In multivariate models, significantly (p<0.05) lower rates of AVS<400 was seen in younger patients, Blacks, Hispanics, IDU risk, HET and CD4<200. For EVS<400, lower rates were seen in younger patients, minorities, IDU risk, HET, patients less engaged in care and patients with CD4<200. Results were similar for VL<50.

Conclusions: VS rates in this statewide sample were higher than in earlier population studies, regardless of VL measure used. However, disparities exist. Further evaluation is needed to explore other factors for non-suppression (adherence, resistance) and quality of care.