title: Early retention in HIV care and viral load suppression: implications for a test and treat approach to HIV prevention.
abstract: BACKGROUND
  After HIV diagnosis and linkage to care, achieving and sustaining viral load (VL) suppression has implications for patient outcomes and secondary HIV prevention. We evaluated factors associated with expeditious VL suppression and cumulative VL burden among patients establishing outpatient HIV care.
  
  
  METHODS
  Patients initiating HIV medical care from January 2007 to October 2010 at the University of Alabama at Birmingham and University of Washington were included. Multivariable Cox proportional hazards and linear regression models were used to evaluate factors associated with time to VL suppression (<50 copies/mL) and cumulative VL burden, respectively. Viremia copy-years, a novel area under the longitudinal VL curve measure, was used to estimate 2-year cumulative VL burden from clinic enrollment.
  
  
  RESULTS
  Among 676 patients, 63% achieved VL <50 copies per milliliter in a median 308 days. In multivariable analysis, patients with more time-updated "no show" visits experienced delayed VL suppression (hazard ratio = 0.84 per "no show" visit, 95% confidence interval = 0.76 to 0.92). In multivariable linear regression, visit nonadherence was independently associated with greater cumulative VL burden (log(10) viremia copy-years) during the first 2 years in care (Beta coefficient = 0.11 per 10% visit nonadherence, 95% confidence interval = 0.04 to 0.17). Across increasing visit adherence categories, lower cumulative VL burden was observed (mean ± standard deviation log(10) copy × years/mL); 0%-79% adherence: 4.6 ± 0.8; 80%-99% adherence: 4.3 ± 0.7; and 100% adherence: 4.1 ± 0.7 log(10) copy × years/mL, respectively (P < 0.01).
  
  
  CONCLUSIONS
  Higher rates of early retention in HIV care are associated with achieving VL suppression and lower cumulative VL burden. These findings are germane for a test and treat approach to HIV prevention.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, USA. mmugavero@uab.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.forename: K Rivet
authors.initials: KR
authors.lastname: Amico
authors.forename: Andrew O
authors.initials: AO
authors.lastname: Westfall
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Crane
authors.forename: Anne
authors.initials: A
authors.lastname: Zinski
authors.forename: James H
authors.initials: JH
authors.lastname: Willig
authors.forename: Julia C
authors.initials: JC
authors.lastname: Dombrowski
authors.forename: Wynne E
authors.initials: WE
authors.lastname: Norton
authors.forename: James L
authors.initials: JL
authors.lastname: Raper
authors.forename: Mari M
authors.initials: MM
authors.lastname: Kitahata
authors.forename: Michael S
authors.initials: MS
authors.lastname: Saag
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000517:prevention & control / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents