O-51 Countdown to control: viral suppression in older adults with HIV from the Midway cohort
Author(s):
S Hurley, A Valentin, S Peck, M DiFiore, A Taylor, K Gattamorta, J Kuretski, H Bolivar, M Ramgopal
Year of Presentation:
2026
Objective: To evaluate real-world time to viral suppression among treatment-naive people with HIV (PWH) aged
≥50 in the current antiretroviral therapy (ART) era, and to
determine whether suppression timelines differ significantly
between older adults and those aged ≤45.
Methods: This retrospective cohort study analyzed treatment-naive PWH who initiated ART between January 2021 and December 2024 across 16 infectious disease clinics in Florida. The primary outcome was time to viral suppression, defined as days from ART initiation to first HIV-1 RNA 100,000 copies/mL. Comparative analysis was conducted between individuals aged ≤45 (n=164) and ≥50 (n=48), using the Mann-Whitney U Test.
Results: Among older adults (≥50 years), the mean age was 60 (range: 50-81), with 27% aged ≥65. Most were cisgender male (71%), and 42% identified as Black. Baseline HIV-1 RNA averaged 166,831 copies/mL; 50% had >100,000 copies/mL. ART initiation occurred >30 days post-diagnosis in 44%, and 83% received INSTI-based regimens. Median time to viral suppression was 60 days (range: 11-546); those ≥65 years had a median of 64.5 days. Individuals with baseline HIV-1 RNA >500,000 copies/mL required a median of 77 days. No significant difference in suppression time was found between age groups (U=3883.00, p=.938).
Conclusion: In this multi-site cohort of treatment-naive PWH, older adults achieved rapid and effective viral suppression comparable to younger individuals, supporting contemporary ART effectiveness across age groups. Given the demographic overlap, particularly the high representation of Black individuals, and populations disproportionately affected by HIV in Caribbean countries, these findings are relevant to the region. In Caribbean healthcare systems, where resource limitations, stigma, and geographic barriers impact ART access, timely initiation of well-tolerated regimens can achieve rapid viral suppression, even among older adults. Expanding access to integrase inhibitor–based therapies and diversifying care beyond centralized clinics may reduce disparities and strengthen patient-centered HIV outcomes across Caribbean populations.