XIX International AIDS Conference


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MOAC0201 - Oral Abstract

Predictors for high vireamia among a treatment-naïve national HIV cohort in the United Kingdom

Presented by Alison Brown (United Kingdom).

A. Brown, A. Aghaizu, G. Murphy, V. Delpech

Heatlh Protection Agency, London, United Kingdom

Background: Viral load is established as the key predictor for HIV transmission; patients adherent to treatment have a negligible transmission risk. In the UK, HIV care is free, and 82% of diagnosed adults receive treatment. We describe the distribution of viral loads and determine the predictors for high vireamia among a treatment-naïve cohort to target groups for prevention.
Methods: Data are taken from HIV positive adults accessing care in the UK in 2010. Patients diagnosed during 2010 were categorised as “recently-infected” (through linkage to avidity test results), “late diagnosed” (CD4 count < 350 within three months of diagnosis) and “other”. High vireamia was defined as >40,000 copies/mL (in line with the upper quartile of the treatment-naïve population). Untreated patients with missing vireamia data (2,343), and those receiving treatment before 2010 (1,543) were excluded; the demographic profile of the included and excluded patients didn´t differ. Multivariate analysis was conducted to identify predictors for high vireamia.
Results: Overall, 8,486 patients were treatment naïve and had a median viral load of 10,494 copies/mL (inter-quartile range (IQR):1,600-42,223); this compares to 39 (IQR:39-49) among the treated population. The number and proportion of patients with high vireamia are presented by risk-group in Figure 1.

Figure 1
[Figure 1]

Predictors for high vireamia include: recent HIV infection (Adjusted Odds Ratio (AOR) 2.8, 95% CI 21-37) and late diagnosis (AOR 2.1, 95%CI 1.7-2.6) (reference: diagnosed < 2010); CD4< 200 (AOR 3.1 95%CI 2.4-4.0) (reference: CD4 351-500); and sex between men (AOR 2.8 95%CI 2.1-3.7) (reference: heterosexual women).
Conclusions: Predictors of high vireamia provide a useful prevention tool. The near three-fold risk of high vireamia among the recently-infected (compared to those diagnosed < 2010) highlights the importance of prompt partner notification. Similarly, elevated vireamia in those diagnosed late - particularly those with CD4< 200 - demonstrates rapid ARV is critical not only clinically, but also for prevention.

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