Publications
Identifying Factors Related to Unsuppressed Viral Load among Older People Living with HIV: A Report to the AIDS Institute and New York State Department of Health ETE Research & Evaluation Mini Grant Projects
2021
Brennan-Ing, M., Kaufman, J. E., Fusaris, E., Correa, A., & Ernst, J. (2021). Identifying factors related to unsuppressed viral load among older people living with HIV. Final report to the New York State Department of Health AIDS Institute, ETE Research & Evaluation Mini Grant Projects. New York: Brookdale Center for Healthy Aging at Hunter College, CUNY.
Mark Brennan-Ing and Jennie Kaufman
Background
In 2015, New York State launched its “Ending the Epidemic” (ETE) Blueprint, an initiative to end AIDS that has gained traction with similar efforts across the U.S. and internationally. One of the three ETE goals is aimed at people who are diagnosed with HIV: “…to link and retain persons diagnosed with HIV to health care and get them on anti-HIV therapy to maximize virus suppression so they remain healthy and prevent further transmission.” The purpose of our study was to identify factors associated with unsuppressed HIV viral load in older and younger adults, and to understand how these factors may differ between those ages 50 and older and 49 and younger. People with HIV (PWH) engaged in care and virally suppressed can achieve life expectancies similar to non-infected peers. As a result, people 50 and older are now estimated to constitute the majority of PWH in the U.S. and in other nations where access to anti-retroviral therapy (ARV) is widely available. To date, we have little information about how the challenges of aging with HIV might affect achieving and maintaining viral suppression among adults 50 and older.
Objectives and Methods
The purpose of this study was to identify factors associated with unsuppressed HIV viral load in PWH, and to understand how aging and age-related factors (multimorbidity, polypharmacy) are associated with viral suppression. This study involves a retrospective chart review and data analysis of the 3,265 members of the Amida Care managed care plan who were continuously enrolled from 2016 through 2019 and who were HIV positive and 18 years or older. We examined independent factors that differentiate five viral suppression groups: PWH who were consistently unsuppressed, PWH who became unsuppressed, PWH whose suppression fluctuated, PWH who achieved sustained viral suppression, and PWH who were consistently virally suppressed. We used cluster analysis to classify viral suppression patterns among Amida Care members. The study protocol was approved by the City University of New York Institutional Review Board.
Findings and Conclusions
PWH with intermittent suppression (became suppressed, became unsuppressed, fluctuated) present the same profile regardless of subgroup classification. Thus, all of these groups may represent subpopulations that fluctuate between suppressed and unsuppressed status. Demographic information is useful in identifying groups at risk for unsustained viral suppression, namely young adults from 18 to 29 years of age, PWH who are non-Hispanic Black, and those who identify as transgender or gender diverse.
Our first hypothesis, that PWH with an unstable connection to a pharmacy and those with behavioral health problems would be at greater risk for being intermittently or consistently unsuppressed, was supported. Our second hypothesis about the association of age and the age-related factors of multimorbidity and polypharmacy with viral suppression patterns was partially supported. We found that PWH who were older had a greater likelihood of being virally suppressed. Physical and behavioral health multimorbidity was strongly associated with viral suppression patterns in a nearly linear fashion, with greater multimorbidity evident in the consistently unsuppressed group and among PWH who transitioned to an unsuppressed state.
Given the strong associations between viremia and physical and behavioral health multimorbidity, it appears that failure to maintain durable viral suppression is part of a syndrome of poor health in this population of PWH. The diagnosis and care of comorbidities that become more common as PWH age must be addressed if the ETE effort is to be successful. More resources should be available to improve access and intensity of patient care. New York State ETE will not be able to achieve its viral suppression targets without a substantial investment in increased and more effective behavioral health care for PWH. We must find ways to increase the capacity of our health care system to address these behavioral health needs. Better information on the effectiveness of behavioral health interventions among PWH is critical for developing programs to improve viral suppression for this subpopulation.