HIV positive patients with antiretroviral therapy and viral suppression
The proportion of HIV-positive patients seen in the United States who had access to antiretroviral therapy (ART) and achieved viral suppression increased substantially between 2009 and 2013, according to research published online in the "AIDS ".
There was an overall increase of 6% in the proportion of patients with prescription antiretroviral drugs, considering that the proportion of individuals with viral suppression and sustained viral suppression increased 11% and 17%, respectively. The increases were most pronounced in young people aged 18-29 and blacks.
"This analysis demonstrates a consistent increase in the prescription of ART (Antiretroviral Therapy) and viral suppression among people under clinical care for HIV infection in the United States globally and in almost all subgroups and demographic characteristics analyzed," The researchers. "However, there is still a significant difference between the percentage of patients receiving ART and those achieving viral suppression."
In 2012, the US Department of Health and Human Services issued updated guidelines recommending that all people with HIV should receive antiretroviral therapy. One of the major goals of the US National HIV / AIDS Strategy is an initiative to increase access to health care and improve outcomes for people with HIV. Undetectable viral load is a key marker for HIV outcomes to be associated with a low risk of disease progression and transmission to sexual partners (to learn more, read about STUDY Partner). Editor's Note: This is the law in Brazil, promulgated by the "out-of-the-way" President (SIC) Dilma Rousseff.
A team of researchers at the Centers for Disease Control and Prevention analyzed data collected between 2009 and 2013 to estimate trends in ART prescription and viral suppression among patients in HIV care.
Data were obtained from the Medical Monitoring Project, a representative national sample of HIV-positive patients in adult patients receiving medical care.
The authors calculated the percentage of ART patients (new and continued prescriptions), viral suppression (viral load below 200 copies / ml at the last follow-up) and sustained viral suppression (viral load below 200 copies / ml in all patients). the tests done in a period of twelve months). -In Brazil, viral suppression is understood as a count of less than forty copies of HIC per milliliter of blood. I do not quite understand the US Health Policy, but in a country where people vote for a president and, depending on the opinion of "delegates and SUPER DELEGATES, whoever lives in the Oval Office is the one who lost the vote popular…
The results were encouraging for all three outcomes.
In 2013, 94% of patients in HIV care were receiving ART and compared to 88,7% in 2009. This increase of 6% was significant (p <0,01). Increases were seen in almost all subgroups. A higher increase was observed for women compared to men (10% versus 5%, respectively). Use of ART increased 24% among patients aged between 18 and 29 years, from 72% in 2009 to 89% in 2013. ART prescription increased 8% among blacks, 7% among Hispanics and 3% among whites. However, in 2013, whites (WASP?) Also demonstrated a significantly greater possibility of receiving ART in relativity to blacks (95% versus 93%, p = 0,01).
Between 2009 and 2013, the proportion of patients with viral suppression increased from 72% to 80%, an increase of 11% (trend, p <0,01). Increases were observed in each subgroup. The magnitude of the increase was higher among women compared to men (16% versus 10%, respectively), but there was a disparity of outcomes according to sex. In 2013, 81% of men and 77% of women had viral suppression (p <0,01). The proportion of younger patients with viral suppression increased by one-fifth. There was an increase of 18% for blacks, twice that observed in whites (8%) and Hispanic (9%). However, a disparity still persisted according to "race" (the quotes are from the translator), with 86% of whites getting viral suppression in 2013 compared to 75% of black skinned people.
The researchers calculated that the increased use of HAART accounted for 30% of the increase in the proportion of patients with viral suppression.
In 2009, 58% of patients had undergone viral suppression. This had increased to 68% in 2013, an increase of 17% over time (trend, p <0,01). Patients had an average of 2,8 viral load tests each year.
Sustained viral suppression increased in the subgroups. 21% increase was observed in women compared to an increase of 16% in men. However in 2013 a higher proportion of men than women had undergone viral suppression (70% versus 64%, p <0,01). A large increase (60%) was observed in the proportion of patients younger than 29 with sustained viral suppression. Despite this, only 51% of this age group had undergone viral suppression in 2013, compared to 74% of patients aged 50 and more. The proportion of black patients with sustained viral suppression increased by nearly a quarter, compared to an increase of 17% in Hispanics and an increase of 14% in whites. However, in 2013 whites were still significantly more likely to achieve viral suppression compared to blacks (76% versus 61%, p <0,01).
The authors estimated that 19% of the increase in the proportion of patients with sustained viral suppression could be attributed to the increased use of ART.
"These findings illustrate progress towards NTEM goals of improving health outcomes for people living with HIV, write the researchers.
They believe that several factors have contributed to this progress.
- Previous onset of ART.
- Improvements in HIV therapy facilitated better adherence, such as reduction of burden, reduced frequency of dosing and safer, less toxic therapies.
- Elimination of the AIDS Drug Assistance Program (adaptation) waiting lists
- Better case management and commitment to care
"Over a period of five years, viral suppression has increased significantly among people receiving clinical HIV care, the researchers conclude. However, they were concerned about the large and continuous gap between the proportion of patients with ART prescription and the percentage with sustained viral suppression.
"Helping patients to sustain viral suppression may require greater efforts from clinical care providers and support service organizations to address the social and behavioral causes of factors affecting access to long-term medication compliance and general health care."
Posted in: 10 from June of 2016 to Aidsmap
Translated by Cláudio Souza in 12 of June of 2016 of the original in Big Increases in proportion of HIV-positive Patients in US treated with ART and viral suppression with
Editor's note: "Anyone can read the text and say, this is in America! So what ?! "Well, I would say that many of us have better results with a virions count below 40 copies per milliliter and therefore we are very well!
No, it is not. There is much to be done here, and in the world, to reach "a world without AIDS" (this world would not include, as far as I can see, China, Russia, Mongolia and "part" of the Middle East). I again hit the key that our media is participatory of what would interest them and I see it as a nightmare dantesto that "concessions of _canais_de_Television_ be given to politicians, with the due respect that I ask the few truly honest, that will only do to implement its (s) without, like a tick, parasitizing without giving anything back to the society that feeds them with costs higher than would be needed to sustain "a donkey to gossip."
What we have is a result of the militancy of the 80 and 90 years, and of some of us who still live (God knows how) and still keep the flame burning. Beware of who you put in certain chairs because, in the dance of the chairs, it is not the dumbest that stands ... It is the weakest ... (...)
Bradley H et al. Increased ART prescription and HIV viral suppression Among persons receiving clinical care for HIV infection. AIDS, online edition. DOI: 10.1097 / QAD.0000000000001164 (2016).