393. Community Viral Load as a Biomarker for Targeted HIV Prevention in Omaha, Nebraska
Session: Poster Abstract Session: HIV Prevention: PrEP and other Targeted Approaches
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • HIV CVL Project Poster.pdf (3.5 MB)
  • Background: Individual viral load reduction is key to decrease HIV transmission. We aimed to determine mean and total clinic viral load per year and over time to determine temporal trends and compare results by age, race, gender and zip code distribution, in order to identify areas for potential intervention. 

    Methods: Retrospective review of viral load of HIV-infected patients at the University of Nebraska Medical Center HIV Clinic, Omaha, NE. The clinic provides care for about 80% of patients in the city. Mean clinic viral load (CVL) was defined as average of the most recent VL of all reported HIV-infected individuals that attended the clinic each year between 2009-2013. Total CVL was defined as the sum of the most recent VL of all reported HIV-infected individuals in the clinic between 2009–2013. This takes into account the number of individuals with HIV as well as each individual's most recent VL. HIV RNA reported as <50 copies/mL or < 20 copies/mL were recoded as "25" for years 2009-2012 and  "10" for 2013. Patient demographics (age, gender, and race/ethnicity), zip code, viral load and CD4 count were collected for each individual.

    Results: 1,388 patients provided at least one measure of HIV RNA over the study period; (fig 1).  Significantly higher CVL was observed for those not on antiretroviral therapy, women, African Americans compared to whites and Hispanics, and individuals between 30 and 50 years of age compared to younger or older patients. Mean CD4 at the last observation for each patient was 570. Clinic's CVL spiked in 2010; significantly decreased by 2011 and remained leveled over the remaining of the study period (fig 1).  There was a trend for higher CVL in North, South and West Omaha (Fig 1). An increase in the proportion of patients with virologic suppression was seen over the 5-year period (fig 3)

    Conclusion :We saw an increase in the proportion of patients with virologic suppression but the trends for CVL were not significant, mainly due to lower CVL values in 2009 and higher values in 2010. Our increasing clinic population (100 more patients by the end of 2013) may have also contributed to this.  Our data indicate the need for targeted prevention efforts for younger patients and African Americans to engage in care, be retained in care, receive antiretroviral therapy and improve adherence.

    Figure 1

    Description: Macintosh HD:Users:usandkovsky:Desktop:Dropbox:Community Viral Load:Presentation2:Slide1.tiff

    Figure 2. Outcomes by Year

    Description: graphs_011915

    Uriel Sandkovsky, MD, MS, FACP, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, Susan Swindells, MBBS, Univ. of Nebraska Med. Ctr., Omaha, NE, Harlan Sayles, MS, College of Public Health, University of Nebraska Medical Center, Omaha, NE and Tyler Burnett, MD, University of Nebraska Medical Center, Omaha, NE

    Disclosures:

    U. Sandkovsky, None

    S. Swindells, None

    H. Sayles, None

    T. Burnett, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.