Gaps in Care up to Nine Months Do Not Worsen Viral Load in Patients With HIV

While current guidelines recommend that HIV primary care visit intervals not exceed 6 months, gaps up to 9 months do not worsen viral load for patients, according to study findings.

Prior studies have demonstrated that gaps in care—defined as going beyond a 6-month interval for care—range from 27% to 63% of patients with a new HIV diagnosis and 25% to 35% of established patients. “However, it is an open question about just how harmful longer gaps in care may be with respect to viral load status,” wrote the authors of the study.

Researchers included 6399 HIV-infected adults from 6 academically affiliated HIV clinics in their analysis. Observation lasted from January 1, 2013 through December 31, 2015. Five gap-intervals were included: less than 6 to 7 months, 7 to 8 months, 8 to 9 months, 9 to 12 months, and 12 or more months. Both a continuous measure—log₁₀ viral load at the opening and closing of the gap—and a dichotomous measure—whether patients initially had viral suppression but lost it by the close of the care gap—were taken.

Log₁₀ viral loads increased as the length of the gap interval increased; however, the changes in viral levels were only significant when the gap was 9 months or more. For those with a 9- to 12-month gap, the geometric mean was 98 copies at the opening of the gap and 137 copies at the closing of the gap. For those with a gap of 12 or more months, the geometric mean was 150 copies at opening and 259 copies at closing.

In the dichotomous analysis, 5242 (82%) patients had a viral load of fewer than 200 copies/mL at the opening of the care gap. Fewer patients became unsuppressed when the gap length was fewer than 12 months than when a gap lasted 12 months or longer. With gaps of 12 months or more, 23% of patients became unsuppressed.

“Many of the patients with shorter gaps in primary care were continuing to adhere to their antiretroviral therapy (ART) regimens and thus maintaining their suppressed load,” wrote the authors. “Patients with longer gaps may not have been adhering as well, and part of that nonadherence may have stemmed from the lack of availability of ART prescriptions for refilling medications given the long interval between primary care visits.”

Younger patients, aged 18 to 49, were less likely to maintain suppression than those aged 50 and older. Those without private health insurance and black patients were also less likely to maintain their suppression.

The authors concluded that interventions among these subpopulations to increase long-term ART adherence can potentially increase the number of patients with durably suppressed viral loads.

Reference

Gardner L, Marks G, Patel U, et al. Gaps up to 9 months between HIV primary care visits do not worsen viral load. [Published online April 1, 2018]. AIDS Patient Care STDs. doi.org/10.1089/apc.2018.0001.