Viral Rebound Among Persons With Diagnosed HIV Who Achieved Viral Suppression, United States

Background Some persons who achieve viral suppression may later experience viral rebound, potentially putting them at risk for transmitting HIV. We estimate the prevalence of, and describe factors associated with, viral rebound among adults with diagnosed HIV in the United States who had ≥2 viral load tests in a 12-month period. Setting The Medical Monitoring Project is an annual cross-sectional survey about the experiences and needs of adults with diagnosed HIV sampled from the National HIV Surveillance System. Methods We analyzed interview and medical record data from 3 Medical Monitoring Project cycles spanning June 2015-May 2018. We analyzed viral load results from the 12-month period before the interview among persons with ≥2 viral load tests who achieved viral suppression. Data were weighted based on known probabilities of selection, adjusted for patient nonresponse, and poststratified to known population totals from the National HIV Surveillance System. Results Among those with ≥2 viral load tests who achieved viral suppression, 7.5% demonstrated viral rebound. In multivariable analyses, viral rebound was higher among non-Hispanic blacks, persons ages 18-39, persons with public insurance, persons recently experiencing homelessness, persons with higher numbers of viral load tests, persons who missed HIV care appointments, and persons with suboptimal adherence to antiretroviral therapy. Conclusions Viral rebound varied by sociodemographic and clinical characteristics. HIV providers can monitor persons at greatest risk for viral rebound and link patients with ancillary services or evidence-based interventions to help them remain virally suppressed. Our findings can inform strategies and interventions implemented under the Ending the HIV Epidemic initiative.