Abstract
BackgroundWith ageing of the HIV-infected population, long-term exposure to treatment, varying adherence, emerging resistance and complications to therapies, effectiveness of Highly Active Antiretroviral Therapy (HAART) needs to be monitored continuously at the population level. The German HIV-1 Seroconverter Cohort is a multi-centre, open, long-term observational cohort including patients with a known or reliably estimated date of HIV-infection i.e. last negative and first positive HIV antibody test within a maximum three-year interval or laboratory evidence of seroconversion. Our study aims to investigate survival improvements and changes in AIDS risk over calendar periods in the German HIV-1 Seroconverter Cohort.MethodsRetrospective (for the pre-1997 period) and prospective (since 1997) data from the German HIV-1 Seroconverter Cohort were used. Time from seroconversion to first AIDS-defining event over calendar periods was analysed by using Cox models adjusting for age at seroconversion, sex, transmission groups and short HIV test interval. Kaplan-Meier methods were used to determine expected survival (remaining AIDS-free) by calendar period.Results2162 seroconverters with 8976 person-years of observation were included in our analysis (up to 31.12.2010). A total of 196 first AIDSdefining events were reported. Two periods i.e. 19972000 and 2007-2010 were statistically associated with a reduction in the risk of AIDS, accounting for an overall reduction of 80%. Compared to1997-2000, hazard ratios were 2.6 (95%CI, 1.6-4.8; p=0.000) in pre-1997 and 0.5 (95%CI, 0.3-0.8; p=0.007) in 20072010. Independent risk factor for AIDS progression was age at seroconversion (HR, 1.3 per 10year-increase; p=0.001).ConclusionHAART effectiveness has improved in the German HIV-1-Seroconverter Cohort. The risk to develop AIDS decreased significantly in 19972000 and in 20072010. However, elderly may require particular monitoring in view of their faster progression to AIDS.
Highlights
With ageing of the HIV-infected population, long-term exposure to treatment, varying adherence, emerging resistance and complications to therapies, effectiveness of Highly Active Antiretroviral Therapy (HAART) needs to be monitored continuously at the population level
This paper aims to present the results of the German HIV-1 Seroconverter study, covering more than 13 years of surveillance, in order to monitor at the population level the progression to acquired immunodeficiency syndrome (AIDS) and associated risk factors over calendar periods
The men who have sex with men (MSM) proportion increased as a proportion of enrolled seroconverters in later calendar periods (65.0% in pre-1997 to 87.6% in 2007–2010)
Summary
With ageing of the HIV-infected population, long-term exposure to treatment, varying adherence, emerging resistance and complications to therapies, effectiveness of Highly Active Antiretroviral Therapy (HAART) needs to be monitored continuously at the population level. Long-term observational studies with reliable HIV-1 seroconversion dates are a good tool to assess the effectiveness of highly active antiretroviral therapy (HAART) at the population level [1]. They use calendar period as a proxy for actual HAART use to circumvent confounding by indication [2]. Diagnosed HIV infections are reported to the Robert Koch-Institute (RKI), the national institute for diseases surveillance and control. In this surveillance system, the date of HIV infection is often unknown. To supplement the mandatory reporting system, the RKI set up in 1997 the HIV-1 Seroconverter study, which allows estimating the time of infection, leading to a reliable determination of AIDS incidence, risk factors for AIDS and time to therapy initiation
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
