Time From HIV Diagnosis to Viral Load Suppression: 2007-2013

Abstract

Background: US guidelines now recommend that all HIV-infected persons receive antiretroviral therapy). HIV prevention is increasingly focused on ensuring that infected persons are diagnosed soon after HIV acquisition and quickly link to care and initiate antiretroviral therapy. We examined trends in time from HIV diagnosis to viral load suppression in King County, WA, to gauge improvement in our HIV care continuum over time.

Methods: We used HIV surveillance data and Cox proportional hazards to evaluate how the time from diagnosis to viral suppression changed among persons newly diagnosed as having HIV in King County, WA, between 2007 and 2013.

Results: A total of 1490 (84%) of 1766 newly diagnosed persons achieved viral suppression in a median time of 213 days (95% confidence interval, 203-229). Thirty-six percent of all persons diagnosed in 2007 and 77% in 2013 were virally suppressed within 12 months of HIV diagnosis (P < 0.0001). Differences in time to suppression by calendar year persisted when stratifying by CD4 count at diagnosis. Race was not significantly associated with time to viral suppression.

Conclusions: Time from HIV diagnosis to viral suppression dramatically declined between 2007 and 2013, and more than three quarters of recently HIV-diagnosed individuals in King County, WA, now achieve viral suppression within a year of diagnosis. This improvement was evident among all persons newly diagnosed as having HIV, regardless of race/ethnicity or CD4 count at time of diagnosis.

Conflict of interest statement

Conflict of Interest: There are no conflicts of interest.

Figures

FIGURE 1

A–C, Kaplan-Meier curves depicting time to viral load suppression by diagnosis year, among those with CD4 counts less than 350 cells/mm3, 350–500 cells/mm3, and greater than 500 cells/mm3 in King County, WA (2007–2013).

FIGURES 2

A–F, Kaplan-Meier curves depicting time to viral load suppression among newly diagnosed cases by age, sex, year of diagnosis, CD4 count, race/ethnicity, and transmission category in King County, WA (2007–2013). HETERO indicates heterosexuals.