Recent Trends in Early Stage Response to Combination Antiretroviral Therapy in Australia

Abstract

Background There have been improvements in combination antiretroviral therapy (cART) over the last 15 years. The aim of this analysis was to assess whether improvements in ART have resulted in improvements in surrogates of HIV outcome. Methods Patients in the Australian HIV Observational Database who initiated treatment using mono/duo therapy prior to 1996, or using cART from 1996 onwards, were included in the analysis. Patients were stratified by era of ART initiation. Median changes in CD4+ and the proportion of patients with detectable HIV viral load (>400 copies/ml) were calculated over the first 4 years of treatment. Probabilities of treatment switch were estimated using the Kaplan-Meier method. Results 2,753 patients were included in the analysis: 28% initiated treatment <1996 using mono/duo therapy; and 72% initiated treatment ≥1996 using cART (30% 1996–99; 12% 2000–03; 11% 2004–07; and 19% ≥2008). Overall CD4 response improved by later era of initiation (p<0.001), although 2000–03 CD4 response was less than that for 1996–99 (p=0.007). The average proportion with detectable viral load from 2 to 4 years post treatment commencement by era was: <1996 mono/duo 0.69 (0.67–0.71); 1996–99 cART 0.29 (0.28–0.30); 2000–03 cART 0.22 (0.20–0.24); 2004–07 cART 0.09 (0.07–0.10); ≥2008 cART 0.04 (0.03–0.05). Probability of treatment switch at 4 years after initiation decreased from 53% in 1996–99 to 29% after 2008 (p<0.001). Conclusions Across the five time-periods examined, there have been incremental improvements for patients initiated on cART, as measured by overall response (viral load and CD4 count), and also increased durability of first-line ART regimens.

Modeling Outcomes of First-Line Antiretroviral Therapy and Rate of CD4 Counts Change among a Cohort of HIV/AIDS Patients in Ethiopia: A Retrospective Cohort Study

“…We proposed a semi-parametric mixed effects model for the longitudinal evolution of CD4 cell counts in order to investigate response to treatment based on individual and average profile plots. There was an overall increase in CD4 cell counts over time which is consistent with other studies [41–44]. As shown by the first derivative plot, the rate of CD4 increase in response of treatment was high during the first 10 months and stabilized later.…”

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

“…This result suggests that regardless of CD4 cell count levels at ART initiation, the durability of the first-line ART regimen is largely unaffected by the pre-treatment HIV-positive diagnosis circumstances. The rate of switching antiretroviral classes or making a major first-line ART modification presented in this analysis are similar to previous AHOD analysis [ 36 , 37 ] and comparable to data published from other similar cohorts [ 38 , 39 ]. As a measure of durability, the time to change of an antiretroviral class is preferred over evaluating any antiretroviral modification, as it is likely to correlate with a treatment failure associated first-to-second line switches [ 36 ].…”

Changes in the incidence and prevalence of human immunodeficiency virus or acquired immunodeficiency syndrome in the South African medical schemes environment: 2005–2015

“…Studies determining both incidence and prevalence rates of HIV or AIDS in the medical schemes environment in South Africa are few. Human immunodeficiency virus and ART studies in developed regions, for instance, the United Kingdom and Australia, 12,13 seldom provide an adequate comparator arm as patients, healthcare systems and individual circumstances are too dissimilar. The results of this study do nonetheless indicate that both incidence and prevalence rates of SA-PLWH who claimed ART through PBM company have increased over the last decade.…”