Active engagement in HIV care critical for achieving virologic suppression

To evaluate predictors of HIV virologic suppression, investigators at the University of California retrospectively reviewed electronic health record data captured from January 2021 to August 2023. The analysis included patients with HIV who had at least 1 detectable viral load (HIV RNA >200 copies/mL) and attended at least 1 clinical encounter during the study period. Patients were stratified into groups based on whether virologic suppression was achieved following detectable viremia. The investigators evaluated sociodemographic data, clinical characteristics, and health care utilization trends to identify factors associated with virologic suppression. Chi-squared and Fisher exact testing were employed for statistical analysis.

Among the study population (N=216), the median age was 53 (IQR, 39-61) years, 91.0% were men, 34.0% were White, 92.0% were on ART, and 53.0% had commercial insurance. During the study period 95.0%, 1.4%, and 3.7% of patients had outpatient, emergency department, and inpatient encounters, respectively. Overall, 39% of the population missed 5 or more health care appointments.

Of 117 patients with detectable HIV viral loads who attended at least 1 scheduled outpatient encounter, 53 patients achieved virologic suppression and 64 continued to have detectable disease.

Compared with patients who had persistent viremia, patients who achieved virologic suppression were more likely to be older (median age, 56 [IQR, 44-64] vs 50 [IQR, 39-59] years; P =.02) and less likely to have hepatitis B surface antigen positivity (98% vs 78%; P =.002). Patients who subsequently achieved virologic suppression initially had lower overall median viral loads (140 vs 701 copies/mL; P <.001) but reported lower rates of ART use in the period before detection (26% vs 50%; P =.009).

Further analysis indicated continued engagement in HIV care was associated with higher likelihood of achieving virologic suppression. Patients who achieved suppression more commonly reported 5 or more outpatient visits in the past year than those with persistent viremia (66% vs 39%; P =.027). They also completed in-person encounters (median, 9 vs 7; P =.003) and underwent HIV viral load testing more frequently (median number of tests, 3 vs 1; P <.001) in the same period. However, patients with persistent viremia more commonly received care at a dedicated HIV clinic (77% vs 49%; P =.003)

The investigators noted patients who achieved virologic suppression missed fewer in-person visits than those with persistent viremia in the period after detection (median, 5 and 6, respectively). Between-group analyses also showed achieving virologic suppression was associated with shorter time to next completed in-person visit (median, 33 vs 48 days).

Study limitations include the single-center, retrospective design, the small sample size, and the possibility of incomplete or missing data.

The investigators concluded, “[T]hese findings highlight the importance of continued outreach and support in promoting engagement along the HIV care continuum.”

By Jessica Nye, PhD

References:

Blair C, David HM. Evaluating linkage to care among patients with HIV viremia in Los Angeles, California. Cureus. Published online September 4, 2025. doi:10.7759/cureus.91612