Summary

Data source: Ontario HIV Laboratory Cohort
 

Key points

  • Viral suppression (defined as a viral load less than 200 copies of HIV per milliliter of blood) has improved over time. Between 2000 and 2015, the percent of people with diagnosed HIV living in Ontario who were virally suppressed doubled from 41% (range: 23 to 46%) to 80% (range: 67 to 81%). Further, the percent of newly diagnosed individuals who achieved viral suppression within 6 months of HIV diagnosis increased from 22% in 2000 to 41% in 2013.
  • In 2015, 91% (range: 84 to 93%) of individuals in care were virally suppressed and 94% (range: 91 to 95%) of those on antiretroviral treatment (ART) were suppressed. These data suggest that when HIV-positive people in Ontario are on treatment and stay on treatment, they tend to achieve viral suppression.
  • The doubling in viral suppression over the past 15 years is likely due to a combination of factors, such as the availability of more effective treatments that are easier to take, adherence support interventions, increases in ART use, and improvements in linkage to care.

 

Figures

Figure 1 Number of people with diagnosed HIV living in Ontario who were virally suppressed, 2000 to 2015


Snapshot: The number of people who were virally suppressed increased from 3,607 in 2000 (range: 2,655 to 4,087) to 12,809 in 2015 (range: 11,742 to 13,016). See Table 1 below for data and definitions.


Figure 2 Percent of people with diagnosed HIV living in Ontario who were virally suppressed, 2000 to 2015


Snapshot: The percent of people with diagnosed HIV who were virally suppressed increased from 40.7% in 2000 (range: 23.3% to 46.1%) to 79.5% in 2015 (range: 67.4% to 80.8%). See Table 1 below for data and definitions.


Figure 3 Percent of people with diagnosed HIV living in Ontario in care who were virally suppressed, 2000 to 2015


Snapshot: The percent of people in care who were virally suppressed increased from 50.1% in 2000 (range: 36.9% to 56.7%) to 91.1% in 2015 (range: 83.5% to 92.5%). See Table 2 below for data and definitions.


Figure 4 Percent of people with diagnosed HIV living in Ontario on ART who were virally suppressed, 2000 to 2015


Snapshot: The percent of people on ART who were virally suppressed increased from 63.2% in 2000 to 89.4% in 2010 (main estimates). Since 2010, the percent increased to 94.4% in 2015 (range: 90.9% to 95.1%). See Table 3 below for data and definitions.


Figure 5 Time from HIV diagnosis to viral suppression for people newly diagnosed with HIV in Ontario, 2000 to 2013


Snapshot: The percent of newly diagnosed people who were virally suppressed within six months of diagnosis was approximately 20% in the early and mid-2000s and increased to 41.4% in 2013. See Table 4 below for data and definitions.
 
Notes: Solid line represents main estimate and shaded area represents range of estimates.
 

Tables and definitions

Table 1 Number and percent of people with diagnosed HIV living in Ontario who were virally suppressed, 2000 to 2015


Estimate of percent suppressed “Virally suppressed” definition (numerator) “Diagnosed” definition (denominator)
Main VL less than 200 copies/mL on last VL test (Main estimate) Nominal HIV-positive diagnostic test or HIV viral load test, and not administratively lost to follow-up after 2 years (Main estimate)
Upper VL less than 200 copies/mL on any VL test (Upper estimate) Nominal HIV-positive diagnostic test or HIV viral load test, and not administratively lost to follow-up after 2 years (Main estimate)
Lower VL less than 200 copies/mL on all VL tests (Lower estimate) Nominal/non-nominal HIV-positive diagnostic test or HIV viral load test, and not administratively lost to follow-up after 3 years (Upper estimate)

 

 Table 2 Number and percent of people with diagnosed HIV living in Ontario in care who were virally suppressed, 2000 to 2015


Estimate of percent suppressed “Virally suppressed” definition (numerator) “In care” denominator (denominator)
Main VL less than 200 copies/mL on last VL test (Main estimate) At least one VL test (Main estimate)
Upper VL less than 200 copies/mL on any VL test (Upper estimate) At least one VL test (Main estimate)
Lower VL less than 200 copies/mL on all VL tests (Lower estimate) At least one VL test (Main estimate)

 

 Table 3 Number and percent of people with diagnosed HIV living in Ontario on ART who were virally suppressed, 2000 to 2015


Estimate of percent suppressed “Virally suppressed” definition (numerator) “On ART” definition (denominator)
Main VL less than 200 copies/mL, and known on ART or ART status missing, on last VL test (Main estimate) Documented on ART, or ART status missing, on last VL test (Main estimate)
Upper VL less than 200 copies/mL, and known on ART or ART status missing, on any VL test (Upper estimate) Documented on ART, or ART status missing, on any VL test (Upper estimate)
Lower VL less than 200 copies/mL, and known on ART or ART status missing, on all VL tests (Lower estimate) Documented on ART, or ART status missing, on all VL tests (Lower estimate)

 

 Table 4 Number and percent of people newly diagnosed with HIV in Ontario who were virally suppressed within a certain period of time after HIV diagnosis, 2000 to 2013


Estimate of percent suppressed “Time to VL suppression” definition (numerator) “Newly diagnosed” definition (denominator)
Main Number of months from HIV diagnosis to first suppressed VL (less than 200 copies/mL) Nominal HIV-positive diagnostic test and no evidence of being previously diagnosed (i.e. no record of a detectable VL test or CD4 count before diagnosis, and first VL after diagnosis not suppressed)

 
Notes: Data provided by Public Health Ontario Laboratory. ART status is documented on viral load (VL) test requisitions by the ordering provider and is missing for 17 to 20% of requisitions.