Trends in ART Prescription and Viral Suppression Among HIV-Positive Young Adults in Care in the United States, 2009-2013

Abstract

Background: Only 13% of HIV-positive young adults are estimated to be virally suppressed and, even among those receiving medical care, HIV-positive young adults are less likely than older adults to take antiretroviral therapy (ART), be adherent, and be virally suppressed. We sought to examine trends in treatment and health outcomes from 2009 to 2013 among HIV-positive young adults (aged 18-24 years) in care.

Setting: The Medical Monitoring Project is a complex sample survey of HIV-infected adults receiving medical care in the United States.

Methods: We used weighted interview and medical record data collected from June 2009 to May 2014 to estimate trends in the prevalence of ART prescription, adherence, side effects, single-tablet ART regimens, regular care utilization, and viral suppression among young adults.

Results: From 2009 to 2013, there were significant increases in ART prescription (76%-87%) and the proportion of young adults taking ART who reported taking single-tablet regimens (49%-62%). There was no significant change in adherence, side effects, or regular care utilization. Although viral suppression at last test did not change (65% at both time periods), the proportion of young adults who were sustainably virally suppressed significantly increased (29%-46%). Accounting for ART prescription and single-tablet regimen use attenuated the sustained viral suppression trend.

Conclusions: Although the level of viral suppression among young adults in care remains suboptimal, the observed increases in ART prescription and sustained viral suppression may be a cause for optimism regarding efforts to improve outcomes for this vulnerable population.

Figure 1

Viral suppression among HIV-positive young adults receiving medical care by year --- Medical Monitoring Project, 2009–2013 Viral suppression, undetectable or <200 copies/mL.