Viremia Trajectories of HIV in HIV-Positive Women in the United States, 1994-2017
| Autor: | Mirjam-Colette Kempf, Michael Plankey, Gerald B. Sharp, Mary Young, Adaora A. Adimora, Joanne Michelle F. Ocampo, Cuiwei Wang, Ruth M. Greenblatt, Kathryn Anastos, Margaret A. Fischl, Seble Kassaye, Tracey E. Wilson, Igho Otofukun, Mardge Cohen |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Viremia HIV Infections Antiviral Agents 03 medical and health sciences 0302 clinical medicine Interquartile range Risk Factors medicine Humans 030212 general & internal medicine Longitudinal Studies Prospective Studies Prospective cohort study Multinomial logistic regression Original Investigation 030505 public health business.industry Research virus diseases General Medicine Women's Interagency HIV Study Odds ratio Middle Aged Viral Load medicine.disease United States 3. Good health Online Only Infectious Diseases Observational study Female 0305 other medical science business Viral load Demography |
| Zdroj: | JAMA Network Open |
| ISSN: | 2574-3805 |
| Popis: | Key Points Question How do longitudinal viral trajectories vary among women with HIV? Findings In a cohort study of 1989 women, 3 trajectories were identified with low (28.6%), intermediate (39.4%), and high (32.0%) probability of viremia. Although younger age, African American or Hispanic race/ethnicity, depression symptoms, drug use, and unstable housing were associated with a high probability of viremia, between 2015 and 2017, 71.2% of women achieved sustained viral suppression, including 35.2% of those in the group with a high probability of viremia. Meaning Despite substantial demonstrated success in decreasing HIV viremia substantially over time for most of the women, continued efforts appear to be needed to address mental health, social, behavioral, and structural factors that continue to be associated with the high probability of sustained viremia. 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 This cohort study examines the changes in viral suppression among HIV-positive women in the United States from 1994 to 2017. |
| Databáze: | OpenAIRE |
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