Abstract
BackgroundAlthough advances in HIV medicine have yielded increasingly better treatment outcomes in recent years, HIV-positive people with access to antiretroviral therapy (ART) still face complex health challenges. The EuroSIDA Study Group surveyed its clinics to explore regional differences in clinic services.MethodsThe EuroSIDA study is a prospective observational cohort study that began enrolling patients in 1994. In early 2014, we conducted a 59-item survey of the 98 then-active EuroSIDA clinics. The survey covered HIV clinical care and other aspects of patient care. The EuroSIDA East Europe study region (Belarus, Estonia, Lithuania, the Russian Federation and Ukraine) was compared to a “non-East Europe” study region comprised of all other EuroSIDA countries.ResultsA larger proportion of clinics in the East Europe group reported deferring ART in asymptomatic patients until the CD4 cell count dropped below 350 cells/mm3 (75 % versus 25 %, p = 0.0032). Considerably smaller proportions of East Europe clinics reported that resistance testing was provided before ART initiation (17 % versus 86 %, p < 0.0001) and that it was provided upon treatment failure (58 % versus 90 %, p = 0.0040). Only 33 % of East Europe clinics reported providing hepatitis B vaccination, compared to 88 % of other clinics (p < 0.0001). Only 50 % of East Europe clinics reported having access to direct-acting antivirals for hepatitis C treatment, compared to 89 % of other clinics (p = 0.0036). There was significantly less tuberculosis/HIV treatment integration in the East Europe group (27 % versus 84 % p < 0.0001) as well as significantly less screening for cardiovascular disease (58 % versus 90 %, p = 0.014); tobacco use (50 % versus 93 %, p < 0.0001); alcohol consumption (50 % versus 93 %, p < 0.0001); and drug use (58 % versus 87 %, p = 0.029).ConclusionsStudy findings demonstrate how specific features of HIV clinics differ across Europe. Significantly more East Europe clinics deferred ART in asymptomatic patients for longer, and significantly fewer East Europe clinics provided resistance testing before initiating ART or upon ART failure. The East Europe group of clinics also differed in regard to hepatitis B vaccination, direct-acting antiviral access, tuberculosis/HIV treatment integration and screening for other health issues. There is a need for further research to guide setting-specific decision-making regarding the optimal array of services at HIV clinics in Europe and worldwide.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1685-x) contains supplementary material, which is available to authorized users.
Highlights
Advances in Human immunodeficiency virus (HIV) medicine have yielded increasingly better treatment outcomes in recent years, HIV-positive people with access to antiretroviral therapy (ART) still face complex health challenges
At the time the clinic survey was conducted, World Health Organization treatment guidelines indicated that ART should always be initiated in HIV-positive people when CD4 cell count levels dropped below 500 cells/ mm3 [19], while European AIDS Clinical Society guidelines recommended using a lower CD4 threshold of 350 cells/mm3 [11]
Our study findings raise important questions about how specific features of HIV clinics might contribute to the geographical differences in patient outcomes in the EuroSIDA study cohort
Summary
Advances in HIV medicine have yielded increasingly better treatment outcomes in recent years, HIV-positive people with access to antiretroviral therapy (ART) still face complex health challenges. Advances in HIV medicine have yielded increasingly better treatment outcomes in recent years, in part because people living with HIV (PHLIV) are offered more effective and more tolerable antiretroviral therapy (ART) regimens with simpler dosing schedules [1]. Deaths from HIV are concentrated in resource-limited countries in sub-Saharan Africa and Southeast Asia [6], the disease continues to claim lives in regions with high levels of treatment coverage. A prospective cohort study of 5185 Spanish PLHIV found that the most common non-AIDS events were psychiatric, liver, kidney, cardiovascular and cancer-related events [10]
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