Beset with numerous life challenges that may compromise their adherence to antiretrovirals (ARVs), many women living with HIV are at substantial long-term risk of developing a detectable viral load.

Publishing their Findings in JAMA Network Open, researchers from the Women’s Interagency HIV Study, an ongoing longitudinal cohort study, analyzed data on 1,989 women with the virus who made at least five study visits between 1994 and 2017. The study sites were in Brooklyn and the Bronx in New York City, Chicago, San Francisco and Washington, DC.

Upon entering the study, the women had an average age of 36.9 years, an average CD4 count of 467 and a median viral load of 6,200. A total of 1,305 (65.6%) of the women were African American.

At study visits conducted every six months, the women received viral load testing and were also interviewed. Using an algorithm, study authors analyzed data regarding whether over time the women had a viral below 200 or at least 200.

This algorithm led the researchers to predict that 568 (28.6%) of the women had a low probability of developing a viral load of 200 or above, while 784 (39.4%) had an intermediate probability and 637 (32%) had a high probability.

By 2017, the average cumulative time spent with a fully suppressed viral load were 18.7 years on the low probability group, 12.2 years in the intermediate group and 5.8 years in the high group.

After adjusting the data to account for various differences between the study members, the researchers found that factors associated with a high probability of having a viral load of 200 or above included being African American compared with being white (2.43-fold increased likelihood), being Latina compared with being white (1.5-fold increased likelihood), having increased levels of depressive symptoms (1.17-fold increased likelihood), using drugs (1.23-fold increased likelihood) and having unstable housing (1.25-fold increased likelihood). Having a lower CD4 count was also associated with a greater likelihood of having an unsuppressed viral load.

Between 2015 and 2017, 71.2% of the women sustained a fully suppressed viral load; of these, 89.6% were considered to have a low probability of having a viral load of 200 or above, 83.4% were in the intermediate probability group and 35.2% were in the high probability group.

Across the study, the proportion of women with a fully suppressed viral load increased as the years progressed.

“The findings from this study,” the authors concluded, “suggest that continued efforts are needed to address mental health, social, behavioral and structural factors that were identified as associated with high probability of HIV viremia over time.”

“Survival is a priority over putting a pill in your mouth for a number of our participants, and that is the public health challenge we must address,” the study’s first author, Seble G. Kassaye, MD, MS, an associate professor of medicine at Georgetown University Medical Center, said in a press release.

To read the study, click here.

To read a press release about the study, click here.