Close to 100% of Active Duty Service Members Initiate ART and Achieve Viral Suppression, CDC Reports

According to recent findings from the CDC, published last week in the Morbidity and Mortality Weekly Report, 93.8% of HIV-positive active-duty service members were on continuous antiretroviral therapy (ART) between the study period of January 2012 and June 2018. Of this group, 99.0% were virally suppressed by the end of their first year on ART, and 96.8% at final follow-up.

Wanting to ensure its members remain healthy and to maintain a “battlefield blood supply,” all active-duty service members are routinely screened for HIV. The Military Health System provides care to those who receive a positive test result; these individuals are also clinically evaluated by infectious disease specialists every 6 to 12 months following their diagnosis.

“HIV infection is a deployment-limiting medical condition for US armed forces in the Department of Defense [DoD],” said the study authors. “The DoD model of HIV care demonstrates that the goals of high ART uptake and viral suppression can be achieved and maintained in a large health care system.”

Data from the Defense Medical Surveillance System on active-duty service members who had their HIV infection diagnosed between January 1, 2012, and December 31, 2017, were analyzed by the Armed Forces Health Surveillance Branch. Final follow-up was in June 2018. There were 2 primary outcomes:

1. ART use within 6 or 12 months or by study’s end
2. Viral suppression, as indicated by HIV RNA less than 200 copies/mL in the first year after starting ART

Overall, numbers were high across the board. Of the 1050 service members included in the initial analysis, 89.4%, 95.4%, and 98.7% received ART within 6 months, within 1 year, or by the end of the study period, respectively. In the subgroup of 793 HIV-positive patients on ART who remained on active duty for at least 1 year following their diagnosis, 93.8% received ART for that entire period, 99.0% reached viral suppression during that time, and final follow-up saw 96.8% had maintained viral suppression.

Among the group that initiated ART within 6 months of their diagnosis, most were older, male (89.5%), Hispanic (93.8%), married (90.3%), serving in the Air Force (98.4%), and officers (91.8%). HIV-positive service members who initiated ART within a year after their diagnosis also were older, married (96.0%), serving in the Air Force (98.4%), and officers (96.5%), but typically female (96.3%) and classified as Asian/Pacific Islander (100%).

Typical time from diagnosis to the first indication of viral suppression decreased throughout the study period, from 6.9 months (interquartile range [IQR], 4.9-10.9) in 2012 to 2.9 months (IQR, 2.5-4.3) in 2017, with the median being 4.6 months (IQR, 2.9-7.2).

“The DoD model of HIV care demonstrates that service members with HIV infection who remain in care receive timely ART and can achieve both early and sustained viral suppression,” the authors noted. “DoD and service-specific HIV-related policies stipulate that progressive clinical illness or immune deficiency necessitates duty restrictions and, potentially, a referral for medical evaluation for continued service. Cumulatively, these policies likely enhance adherence to ART among service members with HIV infection.”

The team of investigators note that their results may not be all-encompassing because their data do not account for treatment adherence and only cover service members on active duty throughout the periods studied.

Reference

Stahlman S, Hakre S, Scott PT, et al. Antiretroviral therapy and viral suppression among active duty service members with incident HIV infection — United States, January 2012—June 2018. MMWR Morb Mortal Wkly Rep. 2020;69(13):366-370. doi: 10.15585/mmwr.mm6913a2.