Abstract
BackgroundThe aim of this study was to develop a standardized method to reconstruct persons’ individual viral load (VL) courses to determine viral suppression and duration of viremia for the HIV care continuum in Germany using longitudinal cohort data.MethodsWe analyzed data from two large, multi-center German cohort studies under the direction of the Robert Koch Institute. We included data from 1999 to 2018 of all diagnosed people and of people who initiated antiretroviral treatment (ART). We developed a model generating virtual VL values and an individual VL course corresponding to real VL measurements with a maximum distance of 180 days, considering ART status and VL dynamics. If the distance between VL measurements was > 180 days, the time between was defined as gap time. Additionally, we considered blips, which we defined as a single detectable VL < 1000 copies/ml within 180 days.ResultsA total of 22,120 people (164,691 person-years, PY) after ART initiation were included in the analyses. The proportion of people with viral suppression (VL < 50 copies/ml) increased from 34% in 1999 to 93% in 2018. The proportion of people with VL < 200 copies/ml increased from 47% in 1999 to 96% in 2018. The proportion of people with viremia > 1000 copies/ml decreased from 37% in 1999 to 3% in 2018. The proportion of people with gap time fluctuated and ranged between 18 and 28%. An analysis of the first VL after gap time showed that 90% showed viral suppression, 5% VL between 50- < 1000 copies/ml and 5% VL > 1000 copies/ml.ConclusionWe provide a method for estimating viral suppression and duration of viremia using longitudinal VL data. We observed a continuous and remarkable increase of viral suppression. Furthermore, a notable proportion of those with viremia showed low-level viremia and were therefore unlikely to transmit HIV. Individual health risks and HIV drug resistance among those with low-level viremia are problematic, and viral suppression remains the goal. In 2018, 93 and 96% of people after ART initiation showed VL < 50 copies/ml and VL < 200 copies/ml, respectively. Therefore, using the threshold of VL < 200 copies/ml, Germany reached the UNAIDS 95 target of viral suppression since 2017.
Highlights
The aim of this study was to develop a standardized method to reconstruct persons’ individual viral load (VL) courses to determine viral suppression and duration of viremia for the Clinical Surveillance of HIV Disease (HIV) care continuum in Germany using longitudinal cohort data
The Joint United Nations Programme on HIV/AIDS (UNAIDS) targets to accelerate the fight against HIV and to end the AIDS epidemic by 2030 aim to increase the proportion of people living with HIV (PLHIV) knowing their diagnosis, of people with diagnosed HIV infection receiving antiretroviral treatment (ART) and of people receiving ART being virally suppressed to 90% by 2020 and to 95% by 2030 [1,2,3]
0.3 a The UNAIDS target of viral suppression using the longitudinal model with VL < 200 copies/ml has been met for PLHIV after ART initiation in the study population in Germany since 2011 b The UNAIDS target of viral suppression using the longitudinal model with VL < 50 copies/ml has been met for PLHIV after ART initiation in the study population in Germany since 2015
Summary
The aim of this study was to develop a standardized method to reconstruct persons’ individual viral load (VL) courses to determine viral suppression and duration of viremia for the HIV care continuum in Germany using longitudinal cohort data. In 2018, 37.9 million people were living with HIV worldwide, and 23.3 million people were accessing ART. Among people who knew their HIV status, 78% were accessing treatment. Among those people, 86% were virally suppressed. This statistic is a considerable increase in recent years compared to 2010, when only 24% of all people living with HIV were accessing treatment. There are large differences across regions and countries regarding the HIV care continuum, with less than 50% of all people living with HIV accessing ART in Eastern Europe, central Asia, the Middle East and North Africa, and new HIV infections and AIDS-related deaths are rising in these regions [4, 5]. Challenges with data quality, appropriate data sources and the absence of standardized definitions could hamper comparisons across countries [6]
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