Temporal trends of time to antiretroviral treatment initiation, interruption and modification: examination of patients diagnosed with advanced HIV in Australia.

Stephen T Wright,Kathy Petoumenos,David A Cooper,Melanie Middleton,Phillip Keen,Mark Kelly,Ann Mcdonald,Ian Woolley,Matthew G Law,On Behalf Of The Australian Hiv Observational Database

doi:10.7448/ias.18.1.19463

Stephen T Wright, Kathy Petoumenos + Show 8 more

Open Access

https://doi.org/10.7448/ias.18.1.19463

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Abstract

IntroductionHIV prevention strategies are moving towards reducing plasma HIV RNA viral load in all HIV-positive persons, including those undiagnosed, treatment naïve, on or off antiretroviral therapy. A proxy population for those undiagnosed are patients that present late to care with advanced HIV. The objectives of this analysis are to examine factors associated with patients presenting with advanced HIV, and establish rates of treatment interruption and modification after initiating ART.MethodsWe deterministically linked records from the Australian HIV Observational Database to the Australian National HIV Registry to obtain information related to HIV diagnosis. Logistic regression was used to identify factors associated with advanced HIV diagnosis. We used survival methods to evaluate rates of ART initiation by diagnosis CD4 count strata and by calendar year of HIV diagnosis. Cox models were used to determine hazard of first ART treatment interruption (duration >30 days) and time to first major ART modification.ResultsFactors associated (p<0.05) with increased odds of advanced HIV diagnosis were sex, older age, heterosexual mode of HIV exposure, born overseas and rural–regional care setting. Earlier initiation of ART occurred at higher rates in later periods (2007–2012) in all diagnosis CD4 count groups. We found an 83% (69, 91%) reduction in the hazard of first treatment interruption comparing 2007–2012 versus 1996–2001 (p<0.001), and no difference in ART modification for patients diagnosed with advanced HIV.ConclusionsRecent HIV diagnoses are initiating therapy earlier in all diagnosis CD4 cell count groups, potentially lowering community viral load compared to earlier time periods. We found a marked reduction in the hazard of first treatment interruption, and found no difference in rates of major modification to ART by HIV presentation status in recent periods.

Highlights

HIV prevention strategies are moving towards reducing plasma HIV RNA viral load in all HIV-positive persons, including those undiagnosed, treatment naıve, on or off antiretroviral therapy
A further 397 participants were excluded from the analysis due to missing diagnosis CD4 cell count
We demonstrate a higher hazard of treatment interruption in those who initiated Antiretroviral therapy (ART) therapy with a higher CD4 cell count aHR 01.96 (1.22, 3.20) compared to those that started with a lower count (CD4 B 350 cells/mL), pB0.001

Summary

Introduction

HIV prevention strategies are moving towards reducing plasma HIV RNA viral load in all HIV-positive persons, including those undiagnosed, treatment naıve, on or off antiretroviral therapy. A proxy population for those undiagnosed are patients that present late to care with advanced HIV The objectives of this analysis are to examine factors associated with patients presenting with advanced HIV, and establish rates of treatment interruption and modification after initiating ART. Conclusions: Recent HIV diagnoses are initiating therapy earlier in all diagnosis CD4 cell count groups, potentially lowering community viral load compared to earlier time periods. HIV prevention strategies are moving towards reducing plasma HIV RNA viral load in all HIV-positive persons, including those undiagnosed, treatment naıve, on or off ART. People with undiagnosed HIV for a large period of time might typically present late to care with

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