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Viral Suppression in the Southern US

With the highest HIV incidence rate in this part of the country, the need to get people from diagnosis to timely antiretroviral therapy (ART) remains an urgent need.

The southern United States has been deeply ravaged by HIV. That portion of the country accounts for approximately 38 percent of the US population and 52% of the HIV infections annually, Aadia Rana, MD, associate professor of Medicine at the University of Alabama-Birmingham and an associate scientist with the UAB Center for AIDS Research, noted.

Rana said with updated HIV testing recommendations and newer treatments, she and colleagues wanted to examine the time to viral suppression (VS) trends.

“As we know having someone virally suppressed sooner is certainly good for their own health outcome, but is also important to limiting transmission as well—so it certainly has public health implications,” Rana stated.

Their study found viral suppression times decreased in Alabama, Louisiana, and Mississippi. The investigators looked at these 3 states in two different time frames: 2012-2015 and 2016-2019.

"The median time in days to VS (95% CI) in (Alabama) AL (n=2547), LA (n=4371), and MS (n=1876) in 2012-2015 was 211.0 (199.0-225.0), 242.0 (230.0-253.0), and 332.0 (308.0-365.0), respectively; this drastically improved in all states during 2016-2019 (AL n=2311, LA n=3845, MS n=1479) to 137.0 (129.0-144.0), 118.0 (112.0-123.0), and 168.0 (160.0-181.0) days,” they wrote in their study.

Louisiana saw the greatest decline in the number of days, and the investigators suspect the expansion of Medicaid in July of 2016 as well as some other HIV care programs based in New Orleans and Baton Rouge were likely factors for the decline.

The findings were presented during the Conference on Retroviruses and Opportunistic Infections (CROI) 2021 virtual sessions,

Contagion spoke to Rana about the background of the south’s challenges with HIV, her study’s findings, and why VS may have gone down more quickly in Louisiana than the other states.