Factors Associated with Elevated HIV RNA Levels in HIV-Infected Individuals

BACKGROUND: Virologic suppression is necessary to reduce the risk of complications from HIV infection and to prevent transmission to other individuals. Understanding factors associated with elevated HIV RNA levels in HIV-infected individuals could lead to interventions to improve engagement in care. METHODS: This retrospective, observational study assessed HIV-infected individuals engaged in care in an urban HIV clinic between April 1, 2015 and March 31, 2016. The electronic medical record was reviewed for demographic and HIV-related factors for all individuals with elevated HIV RNA PCR ≥200 copies/mL (EVL) during the study period. Demographic data were compared with individuals with decreased HIV RNA PCR (DVL) <200 copies/mL. Patients with recent HIV diagnosis within 6 months of EVL were excluded due to the possibility of insufficient time to achieve viral suppression after engagement in care. Statistical analysis including Student T-test and Chi Square test was conducted in SPSS, version 24. RESULTS: There were 519 individuals with EVL with 72 (13.9%) excluded due to recent HIV infection. Of 1,789 patients included in this analysis, 447 (25.0%) had an EVL. The median HIV RNA PCR was 7,240 copies/mL (range 200 to 6,720,990) and median CD4 count was 411 cells/mm(3)(range 1 to 1,510) in the EVL group. Individuals with EVL were more likely to be younger (mean EVL group age 43.4 years ± S.D. 11.7, range 22–77 vs. 47.5 years ± S.D. 12.4, range 19–84 in DVL group) (P < 0.0001). Individuals with EVL were more likely to be Black (82.1%) (with White 9.2% and Hispanic 8.7%) compared with those with DVL (74.8% Black, 12.4% White, 11.6% Hispanic, 1.6% other) (P = 0.004). The EVL group was 59.3% male, 39.8% female and 0.9% transgender vs. 64.8% male, 34.3% female, and 1.0% transgender in the DVL group. The main risk factors for HIV acquisition were heterosexual sex (46.3% of EVL vs. 43.4% DVL), men who have sex with men (31.8% vs. 36.4%) and injection drug use (14.3% vs. 14.6%). There were no significant differences in gender or risk factors for HIV acquisition between the two groups. CONCLUSION: Decreased levels of HIV viremia is a major focus of quality HIV care. Younger age and Black race were associated with elevated HIV RNA levels in individuals engaged in care in a large urban HIV clinic. DISCLOSURES: All authors: No reported disclosures.