Identifying factors related to longitudinal viral load patterns among people living with HIV.

Durable HIV viral suppression is the primary goal of initiatives aimed at ending the HIV epidemic. This study (1) identified viral suppression patterns over a four-year period, and (2) determined the association of viral suppression patterns with demographic characteristics. This study was a retrospective observational analysis of insurance claims data of 2,677 members of a New York City managed care plan who were living with HIV (PLWH). Using cluster analysis, five distinct viral suppression patterns were identified: consistently unsuppressed (15%), became unsuppressed (12%), fluctuated (16%), became suppressed (12%), and consistently suppressed (45%). Adults aged 18-29 were more likely to be consistently unsuppressed than older individuals. Compared to non-Hispanic White individuals, PLWH who were non-Hispanic Black had greater odds of becoming suppressed or becoming unsuppressed, and to be consistently unsuppressed. Hispanic PLWH also had greater odds of being consistently unsuppressed. Transgender or gender diverse PLWH had greater odds of being in the fluctuated viral load group than their cisgender peers. Thus, demographic characteristics are useful in identifying groups at-risk for viremia, reflecting the association of these factors with social determinants of health. Future research should examine how to reduce barriers to healthcare and increase care engagement for these populations.