Efficacy of first-line antiretroviral therapy: differences between hospital-based outpatient units and private practices in Germany

Abstract

Purpose of the study : The efficacy of highly active antiretroviral therapy of HIV-infection (HAART) is influenced by factors like potency of applied drugs, adherence of the patient, or resistance-associated mutations. Up to now, there is little evidence about the impact of the therapeutic setting. Methods: Since 2001, the prospective multicenter study RESINA examines the epidemiology of primary HIV drug resistance in Nordrhein-Westfalen, the biggest federal state of Germany. Longitudinal data of all participants are followed in a cohort. Parameters of patients treated in hospital-based outpatient units were compared to those of participants treated in private practices. All 36 centers were specialized in the care for HIV and AIDS patients. Summary of results: Altogether, 1591 patients were enrolled from 2001 to 2009 with a follow-up until the end of 2010. 1099 cases were treated in hospital-based units, 492 were treated in private practices. Significant differences were found considering baseline characteristics. Patients with further progressed disease and more non-European individuals were cared for in hospital units. Only median age and the rate of primary drug resistance were not significantly different. After 48 weeks, 81.9% of patients in hospital units and 85.9% in private practices had a viral load below the limit of detection (p=0.12). A similar result was seen after 96 weeks (p=0.54). A comparable increase of CD4 cell-count was determined in both groups. Conclusions : The RESINA study covers a large cohort treated in different specialized facilities. We found significant differences in baseline characteristics with more unfavourable parameters in cases at hospital-based units compared to private practices. Nevertheless, treatment outcome was similar up to 2 years after therapy initiation. In conclusion, adminstration of HAART is highly efficacious regardless of treatment setting in Germany.