title: Novel use of surveillance data to detect HIV-infected persons with sustained high viral load and durable virologic suppression in New York City.
abstract: BACKGROUND
  Monitoring of the uptake and efficacy of ART in a population often relies on cross-sectional data, providing limited information that could be used to design specific targeted intervention programs. Using repeated measures of viral load (VL) surveillance data, we aimed to estimate and characterize the proportion of persons living with HIV/AIDS (PLWHA) in New York City (NYC) with sustained high VL (SHVL) and durably suppressed VL (DSVL).
  
  
  RESULTS
  Retrospective cohort study of all persons reported to the NYC HIV Surveillance Registry who were alive and ≥12 years old by the end of 2005 and who had ≥2 VL tests in 2006 and 2007. SHVL and DSVL were defined as PLWHA with 2 consecutive VLs ≥100,000 copies/mL and PLWHA with all VLs ≤400 copies/mL, respectively. Logistic regression models using generalized estimating equations were used to model the association between SHVL and covariates. There were 56,836 PLWHA, of whom 7% had SHVL and 38% had DSVL. Compared to those without SHVL, persons with SHVL were more likely to be younger, black and have injection drug use (IDU) risk. PLWHA with SHVL were more likely to die by 2007 and be younger by nearly ten years, on average.
  
  
  CONCLUSIONS
  Nearly 60% of PLWHA in 2005 had multiple VLs, of whom almost 40% had DSVL, suggesting successful ART uptake. A small proportion had SHVL, representing groups known to have suboptimal engagement in care. This group should be targeted for additional outreach to reduce morbidity and secondary transmission. Measures based on longitudinal analyses of surveillance data in conjunction with cross-sectional measures such as community viral load represent more precise and powerful tools for monitoring ART effectiveness and potential impact on disease transmission than cross-sectional measures alone.
authors.affiliation: New York City Department of Health and Mental Hygiene, New York, New York, United States of America. aterzian@health.nyc.gov
authors.forename: Arpi S
authors.initials: AS
authors.lastname: Terzian
authors.forename: Sara D
authors.initials: SD
authors.lastname: Bodach
authors.forename: Ellen W
authors.initials: EW
authors.lastname: Wiewel
authors.forename: Kent
authors.initials: K
authors.lastname: Sepkowitz
authors.forename: Marie-Antoinette
authors.initials: MA
authors.lastname: Bernard
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Braunstein
authors.forename: Colin W
authors.initials: CW
authors.lastname: Shepard
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D016208:Databases, Factual / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology / Q000821:virology*; D015497:HIV-1 / Q000276:immunology* / Q000502:physiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009519:New York City / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D012189:Retrospective Studies; D019562:Viral Load / Q000276:immunology / Q000502:physiology / Q000706:statistics & numerical data*