Abstract

MOPDC0302 - Poster Discussion Session

Trends in antiretroviral therapy use, HIV RNA plasma viral load and CD4 T-lymphocyte counts at death among HIV-positive persons in care in the United States, 2000-2008

Presented by Keri N Althoff (United States).

K.N. Althoff¹, K. Buchacz², I. Hall², J. Zhang¹, D.B. Hanna¹, P. Rebeiro¹, S.J. Gange¹, R.D. Moore¹, M. Kitahata³, K.A. Gebo¹, J. Martin⁴, A.C. Justice⁵, M. Horberg⁶, R.S. Hogg⁷, T.R. Sterling⁸, A. Cescon⁷, M.B. Klein⁹, J. Thorne¹, H. Crane³, M.J. Mugavero¹⁰, S. Napravnik¹¹, G.D. Kirk¹, L.P. Jacobson¹, B. Rodriguez¹², J.T. Brooks², North American AIDS Cohort Collaboration on Research and Design

¹Johns Hopkins University, Baltimore, United States, ²Centers for Disease Control and Prevention (CDC), Atlanta, United States, ³University of Washington, Seattle, United States, ⁴University of California at San Francisco, San Francisco, United States, ⁵Yale University and the VA Connecticut Healthcare System, New Haven, United States, ⁶Mid-Atlantic Permanente Research Institute, Rockville, United States, ⁷BC Centre for Excellence in HIV/AIDS and Simon Fraser University, Vancouver, Canada, ⁸Vanderbilt University, Nashville, United States, ⁹McGill University, Montréal, Canada, ¹⁰University of Alabama, Birmingham, United States, ¹¹University of North Carolina, Chapel Hill, United States, ¹²Case Western Reserve University, Cleveland, United States

Background: The US National HIV/AIDS Strategy targets for 2015 include “improving health outcomes for people living with HIV.” The objective of this study was to demonstrate the changing national trends in HIV treatment and outcomes among adults in HIV care using the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD).
Methods: We analyzed data from HIV-infected adults in the NA-ACCORD with ≥1 plasma HIV RNA viral load (HIV VL) or CD4 T-lymphocyte (CD4) count measured in an HIV clinical setting in any calendar year from 1/1/2000 to 12/31/2008. Annual percentages of antiretroviral therapy use (ART), suppressed HIV VL, and median age and CD4 count at death were estimated. Χ² statistics were used to compare percentages within a calendar year; generalized linear models with generalized estimating equations were used for comparison across calendar years.
Results: 45,529 HIV-infected adults received care in an NA-ACCORD-participating US clinical cohort from 2000 to 2008. From 2000 to 2008, the percentage of participants using combination ART increased from 73% to 83% (p< 0.01). In 2008, protease inhibitor-based (37%) and non-nucleoside reverse transcriptase-based (57%) regimens were the most commonly prescribed initial combination ART among treatment-naïve adults (p< 0.01). The percentage with suppressed HIV VL (≤2.7 log₁₀copies/mL) increased from 46% in 2000 to 72% in 2008 (p< 0.01) (figure). Among 4,417 participants who died, median age at death increased from 44 to 50 years (p< 0.01) while the CD4 count at death more than tripled to 209 cells/mm³ (p< 0.01).
Conclusions: From 2000-2008, increases were observed in the percentage prescribed combination ART, the percentage who achieved a suppressed HIV VL, and the median age and CD4 count at death. Our data show improved control of HIV with contemporary management in the US and the utility of NA-ACCORD for monitoring these trends.


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