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

Wright, Stephen T ; Law, Matthew G ; Cooper, David A ; Keen, Phillip ; McDonald, Ann ; Middleton, Melanie ; Woolley, Ian ; Kelly, Mark ; Petoumenos, Kathy

Journal of the International AIDS Society, 2015-01, Vol.18 (1), p.19463-n/a [Periódico revisado por pares]

Switzerland: International AIDS Society

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Título:
Temporal trends of time to antiretroviral treatment initiation, interruption and modification: examination of patients diagnosed with advanced HIV in Australia
Autor: Wright, Stephen T ; Law, Matthew G ; Cooper, David A ; Keen, Phillip ; McDonald, Ann ; Middleton, Melanie ; Woolley, Ian ; Kelly, Mark ; Petoumenos, Kathy
Assuntos: Acquired immune deficiency syndrome ; Adult ; advanced HIV diagnosis ; Aged ; AIDS ; AIDS/HIV ; Analysis ; Anti-HIV Agents - therapeutic use ; Antiretroviral agents ; Antiretroviral drugs ; Australia ; Care and treatment ; CD4 Lymphocyte Count ; Collaboration ; combination antiretroviral therapy ; Complications and side effects ; Diagnosis ; Disease transmission ; Drug therapy ; Ethics ; Female ; Health aspects ; Health services ; Hepatitis ; Highly active antiretroviral therapy ; HIV ; HIV infections ; HIV Infections - drug therapy ; HIV Infections - immunology ; HIV Infections - virology ; Hospitals ; Human immunodeficiency virus ; Humans ; Infections ; Infectious diseases ; late diagnosis ; Logistic Models ; Male ; Medical practices ; Medical tests ; Middle Aged ; Population ; Prevention ; Public health ; Risk factors ; Sexually transmitted diseases ; STD ; Time Factors ; treatment interruption ; treatment modification ; Trends ; Viral Load
É parte de: Journal of the International AIDS Society, 2015-01, Vol.18 (1), p.19463-n/a
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
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Descrição: Introduction HIV 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. Methods We 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. Results Factors 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. 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. 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.
Editor: Switzerland: International AIDS Society
Idioma: Inglês

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

Wright, Stephen T ; Law, Matthew G ; Cooper, David A ; Keen, Phillip ; McDonald, Ann ; Middleton, Melanie ; Woolley, Ian ; Kelly, Mark ; Petoumenos, Kathy

Switzerland: International AIDS Society

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