By Will Boggs MD
NEW YORK (Reuters Health) - 1/3/2019
Young black men with HIV have far lower rates of viral suppression than others with HIV, according to results from the Medical Monitoring Project (MMP).
"During 2009-2014, 36% of young black men in HIV care had durable viral suppression (viral suppression at all tests in the previous 12 months)," Dr. Pranesh Chowdhury from the Centers for Disease Control and Prevention (CDC), in Atlanta, told Reuters Health by email. "Additionally, antiretroviral therapy (ART) prescription among this group increased from 61% in 2009-2010 to 88% in 2013-2014. However, there was no significant change over time in either viral suppression or in ART adherence."
Earlier studies have documented substantial increases in ART prescription and viral suppression during 2009-2013, along with substantial reductions in black-white disparities in HIV clinical outcomes. Still, young black individuals have the lowest levels of viral suppression among HIV-diagnosed persons in care.
Dr. Chowdhury and colleagues used MMP data to evaluate trends in ART prescription, adherence and viral suppression among 336 young black men (aged 18-24 years) receiving HIV medical care during 2009-2014.
Most of these men (54.2%) lived at or below federal poverty guidelines, 11.9% had been homeless at some time in the past 12 months, and 52.7% received Ryan White HIV/AIDS Program (RWHAP) assistance to pay for medical care or ART medications.
During 2009-2014, 80.1% of the men were prescribed ART and 72.6% were adherent to ART, but only 35.7% had durable viral suppression.
This compares with viral-suppression rates of 68% among all adults and 51% among young adults aged 18-29 years during 2013, the researchers report in JAIDS, online February 13.
Clinical outcomes were not significantly associated with sexual behavior, education level, household income, homelessness, cigarette smoking, or binge drinking. But ART prescription levels and durable HIV viral suppression were significantly higher among those with any RWHAP assistance (93.2% and 46.0%, respectively) than among those who did not (66.8% and 25.4%).
Current depression was associated with lower ART adherence, and use of injection or non-injection drugs was associated with lower rates of durable HIV viral suppression.
"It is important for people with diagnosed HIV to be promptly linked to care so they can achieve viral suppression to reduce their window of infectiousness and improve their health outcomes," Dr. Chowdhury said. "Efforts among healthcare providers, community-based organizations, and state and local health departments are necessary to strengthen programs that address barriers to HIV care, ART prescription, and medication adherence and to eliminate racial/ethnic disparities."
"Training providers on techniques for promoting trust in patient-provider relationships, addressing structural discrimination and racism in clinical settings, and delivering treatment and implementing CDC recommended high-impact HIV prevention methods for young black men may help to increase ART adherence and viral suppression," he said.
Dr. Chowdhury added, "We're optimistic about today's era of HIV prevention, and must ensure prevention efforts reach all populations equally. But we can't do it alone - CDC continues to look for ways to sound the alarm and urges policymakers, communities and individuals to take action. The Department of Health and Human Services proposed a new federal initiative earlier this month to eliminate the HIV epidemic in America by scaling up four key strategies:
More details about the proposed initiative are available at HIV.gov."
J Acquir Immune Defic Syndr 2019.