Abstract

TUPE035 - Poster Exhibition

Trends in clinic viral load at a public health HIV/AIDS clinic in San Francisco from 2001-2011

E. Geng, C.B. Hare, K. Christopoulos, J. Kahn, M. Gandhi, D.V. Havlir

University of California at San Francisco, San Francisco, United States

Background: Over the last decade, antiretroviral therapy (ART) has become more tolerable and potent and CD4 thresholds for treatment have risen. The extent to which these trends have been translated into routine care in urban, public health, safety-net clinic populations with a high prevalence of psychiatric and psychosocial comorbidities has not been well characterized.
Methods: We evaluated untreated adults (defined as > 90 days without ART use) in a clinic based cohort of patients who entered care at the San Francisco General Hospital HIV/AIDS Clinic from January 1, 2001 to December 30, 2011. We examined the fraction of patients in each calendar year who remained suppressed (< 500c/ml) throughout the year and mean HIV RNA levels across strata of CD4 level at clinic entry.
Results: Among 5,963 patients, 91% were male, median age was 41 years (IQR: 32-47), 53.4% were Caucasian and 23% had history of injecting drug use. The fraction of patients consistently suppressed throughout the year rose steadily from 36.2% in 2001 to 72.3% in 2011 (Figure 1), but trends differed by CD4 level at entry (Figure 2). Between 2001 and 2011, mean HIV RNA levels for patients who enrolled with a CD4 < 200/ul fell from 106,794c/ml to 35,468c/ml; for entry CD4 201-350/ul, from 35,906 to 12,254 c/ml; for entry CD4 351-500/ul, from 21,999 to 13,761 and for CD4 > 500/ul, 36,175 to 22,189 c/ml (Figure 3).
Figure 1: Clinic Distribution of HIV RNA Levels in Patients each Calendar Year


[Figure 1]


Figure 2: Clinic HIV RNA Levels by Entry CD4 Count


[Figure 2]


Figure 3: Mean HIV RNA Levels by Entry CD4 Count


[Figure 3]


Conclusions: In the public health setting, increasingly potent drugs and expanding treatment indications have changed the suppression of HIV RNA from the exception to the rule. Mean clinic viral load declined for all patients groups, but changes plateaued for those with the lowest CD4 levels while they accelerated for those with highest CD4 levels, demonstrating contributions of both more potent therapy and expanding indications to overall reductions in clinic viral load.