Research suggests that significant efforts are needed to help HIV-positive individuals achieve long-lasting viral suppression.
For those who suffer from HIV across the globe who are receiving antiretroviral treatment (ART) adults are getting closer to the goal of 95% achieving viral suppression, but progress in adolescents and children is slow and long-term viral suppression for all groups remains a challenge. These findings of a study sponsored by the National Institutes of Health suggest that substantial efforts are needed to help people with HIV to sustainably fight the virus. The findings were published today in the journal The Lancet HIV.
Viral suppression is a way for people with HIV to safeguard their immune system and keep others from contracting the virus. In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) set a goal of 95% of people with HIV who are taking ART achieving viral suppression by 2030.
In 2020, scientists from the National Institutes of Health-funded International Epidemiology Databases to Evaluate AIDS consortium determined to assess the world’s progress towards reaching this goal. Win Min Han, M.B.B.S.M., M.Sc. was a Ph.D. student and researcher at the Kirby Institute of the University of New South Wales, Sydney, Australia. Azar Kariminia (Ph.D.), Senior lecturer at the Kirby Institute, and Matthew G. Law (Ph.D.), head of the Biostatistics and Databases Program and professor of Biostatistics at Kirby Institute. The funding for IeDEA comes from the National Institute of Allergy and Infectious Diseases (NIAID), part of NIH and comes from eight other NIH institutes and centers.
To estimate the proportion of people who are suppressed virally in children, adolescents, and adults one, two, and three years after initiating treatment, investigators used data from 148 IeDEA sites across five continents and 31 countries. The data were gathered from more than 21,500 adolescents and children with HIV aged 17 or younger, and more than 255,000 adults with HIV who had begun receiving ART between 2010 until 2019. Viral suppression is defined as having less than 1,000 copies of HIV per milliliter of blood.
The researchers calculated the percentages of children and adults who were virally suppressed, based on the data of those who were alive, in follow-up and who had viral load measurements for up to three years of ART. To further estimate viral suppression among those who had fallen out of HIV treatment within three years, investigators looked to an Zambian study of viral suppression rates in a similar population and calculated an adjustment to viral suppression rates in the IeDEA population.
Researchers found that adults were 79% virally suppressed after one year of ART, 72% after two years and 65 percent after three years. In the case of adolescents and children, 64% were virally suppressed after one year of ART and 62 percent after two years, and 59 percent after three years. According to researchers the rates of viral suppression show how far the world’s HIV treatment programs must be to reach and sustain UNAIDS 2030 goals. In addition, the lower rates of HIV suppression in children and adolescents living with HIV emphasize the need for improved strategies to achieve lasting viral suppression in these populations.
Han, W.M. et. the. (2021). Global estimates of viral suppression in children and adolescents receiving antiretroviral treatment. These estimates were adjusted to account for missing viral loads in a multiregional retrospective cohort study in 31 nations. The Lancet HIV. doi.org/10.1016/S2352-3018(21)00265-4.