Journal of acquired immune deficiency syndromes (1999)
October 1, 2026 · via Europe PMC
Association Between Housing Instability and HIV Care Outcomes Among People With HIV in the United States.
Fahey CA, Whitney BM, Drumright LN, +18 more, Chander G.
AI summary — for doctors, generated from the abstract only
Even among people with HIV who are engaged in US clinical care, homelessness and unstable housing were associated with lower viral suppression, ART use, adherence and CD4 counts.
What was studied
An analysis of clinical and patient-reported data from the CFAR Network of Integrated Clinical Systems cohort of adults in HIV care across the US between 2019 and 2025, using relative risk and linear regression to relate self-perceived housing instability to HIV care markers.
Key findings
- Among 6,873 people in care, nearly 10% reported housing instability at their most recent visit (4.6% unstable, 3.3% homeless, 1.7% do not know)
- Viral suppression prevalence was lower with homelessness (PR 0.82, 95% CI 0.77-0.89) and unstable housing (PR 0.94, 95% CI 0.90-0.98)
- ART use, mean adherence and mean CD4 count were also lower
- Results were similar when stratified by substance use and depression and compared with a community-based cohort
Clinical relevance
The findings frame housing as a structural barrier to HIV treatment success that clinical care alone does not overcome, based on a large observational cohort.
Who should care
Limitations
Cross-sectional associations from an observational cohort using self-perceived housing status, so causality and the effect of housing interventions cannot be inferred.
Unstable housing undercuts HIV treatment outcomes even for patients who are showing up to clinic.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
People with HIV (PWH) disproportionately experience homelessness and other forms of housing instability. Understanding how housing status influences HIV clinical outcomes remains limited, especially among individuals engaged in care.
Methods
We evaluated associations between housing status and HIV care markers using clinical data and patient-reported measures from the Centers for AIDS Research Network of Integrated Clinical Systems cohort of adults receiving HIV care across the United States (US), between 2019 and 2025. We used relative risk regression and linear regression to estimate associations between self-perceived housing instability and outcomes including HIV viral suppression (<200 copies/mL), self-reported antiretroviral therapy (ART) use and adherence (visual analog scale), and CD4 cell count, adjusted for demographic characteristics, year, and site.
Results
Among 6873 individuals in clinical care, nearly 10% reported some form of housing instability at their most recent visit: 4.6% "Unstable," 3.3% "Homeless," and 1.7% "Do not know." Compared with stably housed individuals, the prevalence of viral suppression was lower among those experiencing homelessness [prevalence ratios (PR) = 0.82, 95% CI: 0.77 to 0.89] and unstable housing (PR = 0.94, 95% CI: 0.90 to 0.98), as was the prevalence of ART use, mean ART adherence, and mean CD4 count. Results were similar when stratified by substance use and depression and when compared with a community-based cohort of PWH.
Conclusion
Housing instability is associated with a lower prevalence of HIV viral suppression even among individuals engaged in clinical care. These results highlight lack of access to stable housing as a structural barrier to successful management of HIV and to ending the HIV epidemic in the US.
DOI
10.1097/qai.0000000000003906
PMID
42357998
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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