Gaps Up To 9 Months Between HIV Primary Care Visits Do Not Worsen Viral Load

Area of Science:

• Infectious Diseases
• Public Health
• Clinical Medicine

Background:

• Current guidelines recommend HIV viral load monitoring every 6 months.
• Gaps in HIV care exceeding 6 months are frequently observed in clinical practice.
• The impact of varying care gap lengths on viral load status requires further investigation.

Purpose of the Study:

• To examine the association between the length of care gaps and changes in viral load status among US HIV patients.
• To determine the specific duration of care gaps at which significant increases in viral load occur.
• To identify patient subgroups disproportionately affected by longer care gaps.

Main Methods:

• Observational cohort study of 6399 US patients across six HIV clinics.
• Analysis of viral load measurements (continuous and dichotomous) relative to the opening and closing of care gaps.
• Categorization of care gap lengths into strata: >6 to <7, 7 to <8, 8 to <9, 9 to <12, and ≥12 months.

Main Results:

• Viral load increases were nonsignificant or modest for care gaps <9 months, with ≤10% experiencing loss of viral suppression.
• Care gaps of ≥12 months were associated with significant viral load increases and a 23% rate of viral suppression loss.
• Detrimental effects were more pronounced in younger patients, Black patients, and those without private health insurance.

Conclusions:

• Shorter HIV care gaps (under 9 months) are generally not detrimental to viral load status.
• Extended care gaps (≥12 months) pose a significant risk for viral load increase and loss of suppression.
• Current 6-month visit intervals may be adjusted to 6-9 months for select HIV patients to optimize care and outcomes.