Temporal trends of time to antiretroviral treatment initiation,interruption and modification: examination of patients diagnosed with advanced HIV in Australia |
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| Authors: | Stephen T Wright Matthew G Law David A Cooper Phillip Keen Ann McDonald Melanie Middleton Ian Woolley Mark Kelly Kathy Petoumenos on behalf of the Australian HIV Observational Database |
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| Affiliation: | 1.The Kirby Institute, UNSW Australia, Sydney, Australia;2.Health Protection, Communicable Diseases Branch, NSW Government Health, Sydney, Australia;3.Department of Medicine, Monash University, Melbourne, Australia;4.Department of Infectious Diseases, Monash University, Melbourne, Australia;5.Infectious Diseases, Monash Medical Centre, Melbourne, Australia;6.Brisbane Sexual Health and HIV Services, Brisbane, Australia |
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| Abstract: | IntroductionHIV prevention strategies are moving towards reducing plasma HIV RNA viral load in all HIV-positive persons, including those undiagnosed, treatment naïve, on or off antiretroviral therapy. A proxy population for those undiagnosed are patients that present late to care with advanced HIV. The objectives of this analysis are to examine factors associated with patients presenting with advanced HIV, and establish rates of treatment interruption and modification after initiating ART.MethodsWe deterministically linked records from the Australian HIV Observational Database to the Australian National HIV Registry to obtain information related to HIV diagnosis. Logistic regression was used to identify factors associated with advanced HIV diagnosis. We used survival methods to evaluate rates of ART initiation by diagnosis CD4 count strata and by calendar year of HIV diagnosis. Cox models were used to determine hazard of first ART treatment interruption (duration >30 days) and time to first major ART modification.ResultsFactors associated (p<0.05) with increased odds of advanced HIV diagnosis were sex, older age, heterosexual mode of HIV exposure, born overseas and rural–regional care setting. Earlier initiation of ART occurred at higher rates in later periods (2007–2012) in all diagnosis CD4 count groups. We found an 83% (69, 91%) reduction in the hazard of first treatment interruption comparing 2007–2012 versus 1996–2001 (p<0.001), and no difference in ART modification for patients diagnosed with advanced HIV.ConclusionsRecent HIV diagnoses are initiating therapy earlier in all diagnosis CD4 cell count groups, potentially lowering community viral load compared to earlier time periods. We found a marked reduction in the hazard of first treatment interruption, and found no difference in rates of major modification to ART by HIV presentation status in recent periods. |
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| Keywords: | combination antiretroviral therapy late diagnosis advanced HIV diagnosis treatment interruption treatment modification |
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