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A report from the Johns Hopkins HIV Clinic shortly after the introduction of potent antiretroviral therapy (ART) showed that only 44% of patients receiving therapy between 1996 and 1998 achieved viral loads <500 copies/mL (JW AIDS Clin Care Sep 1 1999). Now, an update from the same clinic shows how far we have come.
Researchers evaluated viral-load data for patients seen at the clinic between 1996 and 2010. During this study period, the clinic population became older (with a median age of 49 by 2010) and shifted to include higher proportions of women and of patients who acquired HIV heterosexually. The percentage of patients receiving ART increased from 22% to 85%, and the median viral load for the entire clinic population decreased from 10,000 to <200 copies/mL. In 2010, only 16% of patients had viral loads >500 copies/mL — and many of these individuals were not receiving ART. The rate of retention in care was remarkably high: 94% in 2003–2009.
Moore RD and Bartlett JG. Dramatic decline in the HIV-1 RNA level over calendar time in a large urban HIV practice. Clin Infect Dis 2011 Sep 15; 53:600.
Sax PE. Antiretroviral therapy: Now “it just works.”. Clin Infect Dis 2011 Sep 15; 53:605.
Comment
This study demonstrates that outstanding rates of virologic suppression are possible with potent ART, even in a marginalized inner-city population. The excellent results are likely related to the high retention rate in this clinic, underscoring the fact that engagement with care is key to the successful treatment of HIV infection. However, this is no time to rest on our laurels. The success documented here should inspire efforts toward earlier diagnosis, better linkage to care, and more-widespread therapy. An insightful editorial places this report in historical context and looks forward to an era in which ongoing efforts will lead to reductions in community viral load (already seen in some places) and a lower incidence of HIV transmission.