Changes in viral suppression status among US HIV-infected patients receiving care.

OBJECTIVE: To examine changes in viral suppression status among HIV patients receiving care in 2014 and the extent of viral suppression among persons with infrequent care visits.
METHODS: Using data reported to the National HIV Surveillance System from 33 jurisdictions with complete reporting of CD4 and viral load tests, we created four viral suppression status groups based on their first and last viral loads in 2014: both suppressed, first unsuppressed and last suppressed (improved), first suppressed and last unsuppressed (worsened), and both unsuppressed. We also calculated the number and percentage of persons whose sole viral load in 2014 was suppressed and had a suppressed viral load at their last test in 2013.
RESULTS: Among 339 515 persons with at least two viral load tests in 2014, 72.6% had all viral loads suppressed (durably suppressed); 75.5% had the first and last tests suppressed, 10.5% improved, 4.2% worsened, and 9.9% had both unsuppressed. Among 92 309 persons who had only one viral load test in 2014, 69 960 (75.8%) were suppressed and, of those, 53 834 (76.9%) also had a suppressed viral load at their last test in 2013.
CONCLUSION: National surveillance data show that the majority of patients in HIV care during 2014 were durably suppressed. More showed improved compared with worsened viral suppression status. Some patients who have less frequent care visits have sustained viral suppression. Yet one in 10 who was in regular care did not have a suppressed viral load in 2014, indicating missed opportunities for clinical interventions to help patients achieve and sustain viral suppression.