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Background: Individuals with high HIV viral load (VL) are more likely to transmit HIV and are more likely to be recently infected. VL information at first diagnosis may help health departments better target outreach services by triaging high VL individuals and their partners more quickly and conducting screening in sex partner meeting places frequented by high VL individuals. The objective was to determine characteristics associated with high VL among confirmed HIV-infected individuals tested through the city health department.
Methods: The Baltimore City Health Department implemented a new VL testing protocol among all confirmed HIV-infected individuals tested from October 1, 2012 to July 15, 2013. High VL was defined as a VL greater than 1500 copies/mL. We assessed differences across VL levels using Pearson’s chi-squared and Fisher’s exact tests.
Results: VL testing was conducted on 334 HIV-infected individuals. The majority were male (73.4%), African-American (92.2%), and aged >25 years (83.2%). The mean VL was 10,030 copies/mL; nearly two fifths (37.4%) had a high VL. High VL (vs. low VL) individuals were more likely to be: younger (<25 years) (24.0% vs. 12.4% p=0.006), men who have sex with men (MSM) (36.8% vs. 19.1%, p=0.0004), newly diagnosed (48.0% vs. 15.3%, p< 0.0001), and co-infected with gonorrhea (4.0% vs. 0.5%, p=0.03). High VL (vs. low VL) individuals were more likely to be assigned for routine partner services interviews per standard protocols (newly diagnosed or HIV-positive with an incident bacterial sexually transmitted infections); however, among high VL individuals, half (48.8%) were not assigned to interview, and a third (32.8%) had no identified HIV risk exposure.
Conclusions: High VL individuals were more likely to be young, MSM, newly diagnosed with HIV, and co-infected with gonorrhea. Enhanced follow-up of high VL individuals may be an important targeted HIV control strategy for this urban setting.