LBPE29 - Poster Exhibition
Trends in antiretroviral therapy initiation and virologic suppression among newly clinically-eligible HIV-infected individuals in North America, 2001 to 2009
D.B. Hanna1, K. Buchacz2, K.A. Gebo1, N.A. Hessol3, M.A. Horberg4, L.P. Jacobson1, G.D. Kirk1, M.M. Kitahata5, P.T. Korthius6, R.D. Moore1, S. Napravnik7, P. Patel2, M.J. Silverberg8, T.R. Sterling9, J.H. Willig10, B. Lau1, K.N. Althoff1, A.D. Collier5, M.E. Ohl11, J.E. Thorne1, M.J. Gill12, M.B. Klein13, J.N. Martin3, B. Rodriguez14, S.B. Rourke15, S.J. Gange1, North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the IeDEA
1Johns Hopkins University, Baltimore, United States, 2Centers for Disease Control and Prevention (CDC), Atlanta, United States, 3University of California, San Francisco, San Francisco, United States, 4Kaiser Permanente, Rockville, United States, 5University of Washington, Seattle, United States, 6Oregon Health and Science University, Portland, United States, 7University of North Carolina at Chapel Hill, Chapel Hill, United States, 8Kaiser Permanente, Oakland, United States, 9Vanderbilt University, Nashville, United States, 10University of Alabama at Birmingham, Birmingham, United States, 11Iowa City VA Medical Center, Iowa City, United States, 12University of Calgary, Calgary, Canada, 13McGill University, Montreal, Canada, 14Case Western Research University, Cleveland, United States, 15University of Toronto, Toronto, Canada
Background: Since the mid-1990s, effective antiretroviral therapy (ART) regimens have improved in potency, tolerability, ease of use, and class diversity. We documented increases in treatment initiation and resulting HIV virologic suppression that have occurred in a large cohort of individuals from the United States and Canada between 2001 and 2009.
Methods: We analyzed data from HIV-infected individuals who were newly clinically-eligible for ART (i.e., a first reported CD4+ < 350 cells/uL or AIDS-defining illness, based on treatment guidelines current until 12/2009) from 17 cohorts of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). We estimated the cumulative incidence of ART initiation (through 6 months after eligibility) and virologic suppression (500 copies/mL or less, through 1 year after eligibility) by calendar year. We adjusted for age, sex and HIV transmission risk, race/ethnicity, CD4+ count and viral load at eligibility, cohort type, state or province of residence, and documented psychosocial barriers to ART initiation, including non-injection drug abuse, alcohol abuse, and mental illness. We also estimated the cumulative incidence of virologic suppression one year after initiating ART.
Results: Among 10,577 individuals, the adjusted cumulative incidence of ART initiation at 6 months of eligibility increased from 52% (95% CI 49-55) in 2001 to 73% (95% CI 70-75) in 2009 (P trend < 0.001). The adjusted cumulative incidence of virologic suppression at one year increased from 55% (95% CI 51-58) in 2001 to 81% (95% CI 78-84) in 2009 (P trend < 0.001), and among ART initiators, from 83% (95% CI 79-87) in 2001 to 92% (95% CI 89-94) in 2009 (P trend < 0.001).
Conclusions: In the last decade, timely ART initiation and resulting virologic suppression have greatly improved in North America concurrent with the introduction of better regimens. As ART is now being recommended regardless of CD4+ cell count, monitoring these trends should continue.
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