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Too Many People Living with HIV Are Failing to Achieve Lasting Viral Suppression

Rates of sustained viral suppression among people living with HIV were lower than expected, especially among children and adolescents.

A study published today in The Lancet examined whether children, adolescents, and adults living with HIV and receiving antiretroviral therapy are achieving and maintaining viral suppression.

The Joint United Nations Program on HIV/AIDS (UNAIDS) set a “95-95-95” goal for the year 2030. UNAIDS hopes to have 95% of people living with HIV know their status, 95% of people who know their status receive treatment, and 95% on people on HIV treatment achieve viral suppression.

While adults receiving antiretroviral therapy (ART) are slowly reaching this 95% viral suppression target, achieving long-term viral suppression has proven difficult, with children and adolescents lagging even further behind.

Investigators from the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium, funded by the National Institutes of Health, examined how close the world was to reaching the 95-95-95 target.

Analyzing 148 IeDEA treatment sites across 31 countries on 5 continents, the investigators estimated the proportion of children, adolescents, and adults who reached viral suppression 1, 2, and 3 years after beginning an ART regimen.

The study population included 21500 children and teens living with HIV and over 255000 adults with HIV, all of whom began ART between January 1, 2010 and December 31, 2019.

Patients were considered to have achieved viral suppression when they had fewer than 1000 copies of HIV per milliliter of blood.

The investigators found 79% of adults on ART were virally suppressed after 1 year of ART, 72% after 2 years, and 65% after 3 years. Among children and adolescents, 64% were virally suppressed after 1 year of ART, 62% after 2 years, and 59% after 3 years.

The viral suppression rates are far lower than needed to meet UNAIDS’s 95-95-95 goal by 2030. The investigators concluded that global HIV treatments need to go farther to reach and sustain viral suppression among people on ART; these efforts should be doubled for children and adolescents.