International AIDS Society

Sub-500 Viral Load Rate Rises 26% From 2000 to 2008 in United States

Author: Mark Mascolini

19 September 2012

Almost three quarters of NA-ACCORD US cohort members had a viral load below 500 copies/mL in 2008, a 26% improvement since 2000, according to results of a 45,529-person analysis. The proportion of people taking combination antiretroviral therapy (ART) rose 9% in that period.

NA-ACCORD is the largest collaborative study of HIV cohorts that enroll people receiving care in the United States. The NA-ACCORD team estimates that the collaborative cohort includes about 3% of people living with HIV in the United States (PLWH-US), which consists of people reported to national surveillance systems in 40 states.

The aim of this study was to demonstrate the utility of NA-ACCORD in monitoring trends in the US epidemic. NA-ACCORD also includes Canadian cohorts, which were not considered in this study. The analysis focused on HIV-positive adult outpatients with 1 or more viral load measures or CD4 counts recorded in any year from 1 January 2000 to 31 December 2008.

There were 45,529 HIV-positive adults in NA-ACCORD cohorts during the study period. The 26,030 NA-ACCORD participants with data recorded in 2008 were demographically similar to the 655,966 PLWH-US.

From 2000 to 2008 the proportion of NA-ACCORD members prescribed ART rose from 74% to 83%, a highly significant change (P < 0.001). Over the same period the proportion of cohort members with a viral load below 500 copies/mL jumped 26% to 72% (P < 0.001). Median CD4 count at the time of death climbed from 149 to 209 cells/µL.

The authors propose that “the NA-ACCORD is uniquely positioned to provide timely longitudinal data on the clinical epidemiology and health of adults living with HIV infection in the United States.” They note that new cohorts continue to join NA-ACCORD and they “expect their addition to increase the similarity of NA-ACCORD participants to a national probability sample of persons living with HIV infection.”

Source: Keri N. Althoff, Kate Buchacz, H. Irene Hall, Jinbing Zhang, David B. Hanna, Peter Rebeiro, Stephen J. Gange, Richard D. Moore, Mari M. Kitahata, Kelly A. Gebo, Jeffrey Martin, Amy C. Justice, Michael A. Horberg, Robert S. Hogg, Timothy R. Sterling, Angela Cescon, Marina B. Klein, Jennifer E. Thorne, Heidi M. Crane, Michael J. Mugavero, Sonia Napravnik, Gregory D. Kirk, Lisa P. Jacobson, John T. Brooks, and for the North American AIDS Cohort Collaboration on Research and Design. U.S. trends in antiretroviral therapy use, HIV RNA plasma viral loads, and CD4 T-lymphocyte cell counts among HIV-infected persons, 2000 to 2008. Annals of Internal Medicine. 2012;157:325-335.

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