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).
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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