Factors Associated with Elevated HIV RNA Levels in HIV-Infected Individuals. (4th October 2017)

• Record Type: Journal Article
• Authors: Degener, Tyler; Allen, Sara; Wilson, Alicia; Baranoski, Amy
• Is Part Of: Open forum infectious diseases. Volume 4(2017)Supplement 1
• Page Start: S421
• Page End: S421
• Publication Date: 2017-10-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofx163.1057
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Virologic suppression is necessary to reduce the risk of complications from HIV infection and to prevent transmission to other individuals. Understanding factors associated with elevated HIV RNA levels in HIV-infected individuals could lead to interventions to improve engagement in care. Methods: This retrospective, observational study assessed HIV-infected individuals engaged in care in an urban HIV clinic between April 1, 2015 and March 31, 2016. The electronic medical record was reviewed for demographic and HIV-related factors for all individuals with elevated HIV RNA PCR ≥200 copies/mL (EVL) during the study period. Demographic data were compared with individuals with decreased HIV RNA PCR (DVL) <200 copies/mL. Patients with recent HIV diagnosis within 6 months of EVL were excluded due to the possibility of insufficient time to achieve viral suppression after engagement in care. Statistical analysis including Student T-test and Chi Square test was conducted in SPSS, version 24. Results: There were 519 individuals with EVL with 72 (13.9%) excluded due to recent HIV infection. Of 1, 789 patients included in this analysis, 447 (25.0%) had an EVL. The median HIV RNA PCR was 7, 240 copies/mL (range 200 to 6, 720, 990) and median CD4 count was 411 cells/mm 3 (range 1 to 1, 510) in the EVL group. Individuals with EVL were more likely to be younger (mean EVL group age 43.4 years ± S.D. 11.7, range 22–77 vs. 47.5 years ± S.D. 12.4, range 19–84 in DVL group) ( P < 0.0001). Individuals with EVL were more likely to be Black (82.1%) (with White 9.2% and Hispanic 8.7%) compared with those with DVL (74.8% Black, 12.4% White, 11.6% Hispanic, 1.6% other) ( P = 0.004). The EVL group was 59.3% male, 39.8% female and 0.9% transgender vs. 64.8% male, 34.3% female, and 1.0% transgender in the DVL group. The main risk factors for HIV acquisition were heterosexual sex (46.3% of EVL vs. 43.4% DVL), men who have sex with men (31.8% vs. 36.4%) and injection drug use (14.3% vs. 14.6%). There were no significant differences in gender or risk factors for HIV acquisition between the two groups. Conclusion: Decreased levels of HIV viremia is a major focus of quality HIV care. Younger age and Black race were associated with elevated HIV RNA levels in individuals engaged in care in a large urban HIV clinic. Disclosures: All authors: No reported disclosures.