Impact of age on retention in care and viral suppression

Baligh R. Yehia, Peter Rebeiro, Keri Althoff, Allison Lorna Agwu, Michael A. Horberg, Hasina Samji, Sonia Napravnik, Kenneth Mayer, Ellen Tedaldi, Michael J. Silverberg, Jennifer Thorne, Ann N. Burchell, Sean B. Rourke, Anita Rachlis, Angel Mayor, Michael J. Gill, Anne Zinski, Michael Ohl, Kathryn Anastos, Alison Gump AbrahamMari M. Kitahata, Richard D Moore, Kelly Gebo

Research output: Contribution to journalArticle

Abstract

Background: Retention in care is important for all HIV-infected persons and is strongly associated with initiation of antiretroviral therapy and viral suppression. However, it is unclear how retention in care and age interact to affect viral suppression. We evaluated whether the association between retention and viral suppression differed by age at entry into care. Methods: Cross-sectional analysis (2006-2010) involving 17,044 HIV-infected adults in 14 clinical cohorts across the United States and Canada. Patients contributed 1 year of data during their first fullcalendar year of clinical observation. Poisson regression examined associations between retention measures [US National HIV/AIDS Strategy (NHAS), US Department of Health and Human Services (DHHS), 6-month gap, and 3-month visit constancy] and viral suppression (HIV RNA ≤200 copies/mL) by age group: 18-29 years, 30-39 years, 40-49 years, 50-59 years, and 60 years or older. Results: Overall, 89% of patients were retained in care using the NHAS measure, 74% with the DHHS indicator, 85% did not have a 6- month gap, and 62% had visits in 3-4 quarters of the year; 54% achieved viral suppression. For each retention measure, the association with viral suppression was significant for only the younger age groups (18-29 and 30-39 years): 18-29 years [adjusted prevalence ratio (APR) = 1.33, 95% confidence interval (CI): 1.03 to 1.70]; 30-39 years (APR = 1.23, 95% CI: 1.01 to 1.49); 40-49 years (APR = 1.06, 95% CI: 0.90 to 1.22); 50- 59 (APR = 0.92, 95% CI: 0.75 to 1.13); ≥60 years (APR = 0.99, 95% CI: 0.63 to 1.56) using the NHAS measure as a representative example. Conclusions: These results have important implications for improving viral control among younger adults, emphasizing the crucial role retention in care plays in supporting viral suppression in this population.

Original languageEnglish (US)
Pages (from-to)413-419
Number of pages7
JournalJournal of Acquired Immune Deficiency Syndromes
Volume68
Issue number4
DOIs
StatePublished - Apr 1 2015

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HIV
Confidence Intervals
United States Dept. of Health and Human Services
Acquired Immunodeficiency Syndrome
Age Groups
Canada
Young Adult
Cross-Sectional Studies
Observation
RNA
Population
Therapeutics

Keywords

  • age
  • engagement
  • HIV
  • retention in care
  • viral suppression

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Impact of age on retention in care and viral suppression. / Yehia, Baligh R.; Rebeiro, Peter; Althoff, Keri; Agwu, Allison Lorna; Horberg, Michael A.; Samji, Hasina; Napravnik, Sonia; Mayer, Kenneth; Tedaldi, Ellen; Silverberg, Michael J.; Thorne, Jennifer; Burchell, Ann N.; Rourke, Sean B.; Rachlis, Anita; Mayor, Angel; Gill, Michael J.; Zinski, Anne; Ohl, Michael; Anastos, Kathryn; Abraham, Alison Gump; Kitahata, Mari M.; Moore, Richard D; Gebo, Kelly.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 68, No. 4, 01.04.2015, p. 413-419.

Research output: Contribution to journalArticle

Yehia, BR, Rebeiro, P, Althoff, K, Agwu, AL, Horberg, MA, Samji, H, Napravnik, S, Mayer, K, Tedaldi, E, Silverberg, MJ, Thorne, J, Burchell, AN, Rourke, SB, Rachlis, A, Mayor, A, Gill, MJ, Zinski, A, Ohl, M, Anastos, K, Abraham, AG, Kitahata, MM, Moore, RD & Gebo, K 2015, 'Impact of age on retention in care and viral suppression', Journal of Acquired Immune Deficiency Syndromes, vol. 68, no. 4, pp. 413-419. https://doi.org/10.1097/QAI.0000000000000489
Yehia, Baligh R. ; Rebeiro, Peter ; Althoff, Keri ; Agwu, Allison Lorna ; Horberg, Michael A. ; Samji, Hasina ; Napravnik, Sonia ; Mayer, Kenneth ; Tedaldi, Ellen ; Silverberg, Michael J. ; Thorne, Jennifer ; Burchell, Ann N. ; Rourke, Sean B. ; Rachlis, Anita ; Mayor, Angel ; Gill, Michael J. ; Zinski, Anne ; Ohl, Michael ; Anastos, Kathryn ; Abraham, Alison Gump ; Kitahata, Mari M. ; Moore, Richard D ; Gebo, Kelly. / Impact of age on retention in care and viral suppression. In: Journal of Acquired Immune Deficiency Syndromes. 2015 ; Vol. 68, No. 4. pp. 413-419.
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AU - Rebeiro, Peter

AU - Althoff, Keri

AU - Agwu, Allison Lorna

AU - Horberg, Michael A.

AU - Samji, Hasina

AU - Napravnik, Sonia

AU - Mayer, Kenneth

AU - Tedaldi, Ellen

AU - Silverberg, Michael J.

AU - Thorne, Jennifer

AU - Burchell, Ann N.

AU - Rourke, Sean B.

AU - Rachlis, Anita

AU - Mayor, Angel

AU - Gill, Michael J.

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AU - Ohl, Michael

AU - Anastos, Kathryn

AU - Abraham, Alison Gump

AU - Kitahata, Mari M.

AU - Moore, Richard D

AU - Gebo, Kelly

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N2 - Background: Retention in care is important for all HIV-infected persons and is strongly associated with initiation of antiretroviral therapy and viral suppression. However, it is unclear how retention in care and age interact to affect viral suppression. We evaluated whether the association between retention and viral suppression differed by age at entry into care. Methods: Cross-sectional analysis (2006-2010) involving 17,044 HIV-infected adults in 14 clinical cohorts across the United States and Canada. Patients contributed 1 year of data during their first fullcalendar year of clinical observation. Poisson regression examined associations between retention measures [US National HIV/AIDS Strategy (NHAS), US Department of Health and Human Services (DHHS), 6-month gap, and 3-month visit constancy] and viral suppression (HIV RNA ≤200 copies/mL) by age group: 18-29 years, 30-39 years, 40-49 years, 50-59 years, and 60 years or older. Results: Overall, 89% of patients were retained in care using the NHAS measure, 74% with the DHHS indicator, 85% did not have a 6- month gap, and 62% had visits in 3-4 quarters of the year; 54% achieved viral suppression. For each retention measure, the association with viral suppression was significant for only the younger age groups (18-29 and 30-39 years): 18-29 years [adjusted prevalence ratio (APR) = 1.33, 95% confidence interval (CI): 1.03 to 1.70]; 30-39 years (APR = 1.23, 95% CI: 1.01 to 1.49); 40-49 years (APR = 1.06, 95% CI: 0.90 to 1.22); 50- 59 (APR = 0.92, 95% CI: 0.75 to 1.13); ≥60 years (APR = 0.99, 95% CI: 0.63 to 1.56) using the NHAS measure as a representative example. Conclusions: These results have important implications for improving viral control among younger adults, emphasizing the crucial role retention in care plays in supporting viral suppression in this population.

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