Of our patient cohort , 122 ( 32.8 %) of all patients were reported as having been infected within WV . Of the patients entering care for the first time after diagnosis of HIV infection , the proportion of patients self-reported to be infected within the state compared to those infected outside the state ranged from 54.2 % from 2009-2012 to 58.6 % between 2015-2018 . These percentages were not significantly different over the period of study . Sexual transmission remained the most common reported risk factor for HIV transmission , reported by 318 ( 85.5 %) of the cohort . Injection drug use ( IDU ) was the next most common risk factor , reported by 10.8 % of patients . More than half ( 58.5 %) of the patients identified as men who have sex with men .
For patients enrolled in care with a diagnosis of new HIV infection made within WV , the mean time to enrollment was 2.7 weeks , compared to 10.8 weeks for patients outside WV . This time difference was statistically significant ( p < 0.001 ). Patients diagnosed within WV were also significantly more likely to have a lower time duration between diagnosis and initiation of combination antiretroviral therapy ( cART ), at 4.2 vs 27.0 weeks , p < 0.001 . The mean CD4 count at the time of establishment was significantly lower for patients diagnosed within WV . The mean duration of enrollment was not statistically significant for patients diagnosed within or outside WV .
In a binary logistic regression model comparing patients infected within WV compared to those infected outside WV , a diagnosis of hypertension was the only comorbid condition more likely to be present in patients infected within WV , OR 12.2 ( CI 1.5-97.4 ). In a second regression model com paring reported risk factors for HIV infection , no significant differences were found .
DISCUSSION
The RW clinic in Morgantown , WV , has maintained a greater than 90 % viral suppression and retention of care rate based on the data from February 2019 . Despite the high rates of viral suppression and engagement in care in comparison to national data , 8 we did not find a significant decline over time in the ratio of patients newly infected with HIV within WV . This
TABLE 2 : HIV Infection Statistics Based on Location at First Detection CD4 Count at Establishment Mean ( s . d ) p-value WV 371 ( 324.2 ) 0.001 Outside WV 482 ( 153.7 ) Weeks Enrolled Mean ( s . d ) p-value WV 184.3 ( 155.7 ) 0.339 Outside WV 168.9 ( 153.7 ) Time from Diagnosis to Establishment for HIV Care ( Weeks ) Mean ( s . d ) p-value WV 2.7 ( 5.4 ) < 0.001 Outside WV 10.8 ( 8.3 ) Duration to cART ( Weeks ) Mean ( s . d ) p-value WV 4.2 ( 20.7 ) < 0.001 Outside WV 27.0 ( 55.8 )
HIV = Human immunodeficiency virus ; WV = West Virginia ; cART = combination anti-retroviral therapy
TABLE 3 : Transmission Statistics for Newly Diagnosed HIV Patients Year Infected In-State Infected Out-of-State p-value 2009-2012 26 ( 54.2 %) 22 0.199 2013-2015 25 ( 58.1 %) 18 2016-2018 17 ( 58.6 %) 12 HIV = Human immunodeficiency virus
TABLE 4 : CAREWare Data for Patients in the Ryan White Service Area
Total Number of Patients in Care 315 Number currently active 294 Retained in care 93 %
Total Number of Patients on cART 277 Number with viral load < 200 253 Viral suppression rate 91 %
Proportion of All HIV Patients in the Service Area that Know of Diagnosis
0.86 ( est , national data )
HIV Transmission Statistics WV National 8
HIV positive patients in the service area that are virologically suppressed
HIV positive patients in the service area potentially contributing to ongoing HIV transmission
HIV = Human immunodeficiency virus ; WV = West Virginia ; cART = combination anti-retroviral therapy
lack of a significant change in the rate of infection likely points to a need for all HIV
69 % 30 %
31 % 70 % 8
programs in the state to demonstrate high viral suppression . In the absence of a re-
26 • www . wvsma . org