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. 2010 May 27:7:14.
doi: 10.1186/1742-6405-7-14.

Outcomes of highly active antiretroviral therapy in the context of universal access to healthcare: the U.S. Military HIV Natural History Study

Vincent C Marconi  1 , Greg A Grandits, Amy C Weintrob, Helen Chun, Michael L Landrum, Anuradha Ganesan, Jason F Okulicz, Nancy Crum-Cianflone, Robert J O'Connell, Alan Lifson, Glenn W Wortmann, Brian K Agan; Infectious Disease Clinical Research Program HIV Working Group (IDCRP)
Affiliations

Outcomes of highly active antiretroviral therapy in the context of universal access to healthcare: the U.S. Military HIV Natural History Study

Vincent C Marconi et al. AIDS Res Ther. .

Abstract

Background: To examine the outcomes of highly-active antiretroviral therapy (HAART) for individuals with free access to healthcare, we evaluated 2327 patients in a cohort study composed of military personnel and beneficiaries with HIV infection who initiated HAART from 1996 to the end of 2007.

Methods: Outcomes analyzed were virologic suppression (VS) and failure (VF), CD4 count changes, AIDS and death. VF was defined as never suppressing or having at least one rebound event. Multivariate (MV) analyses stratified by the HAART initiation year (before or after 2000) were performed to identify risk factors associated with these outcomes.

Results: Among patients who started HAART after 2000, 81% had VS at 1 year (N = 1,759), 85% at 5 years (N = 1,061), and 82% at 8 years (N = 735). Five years post-HAART, the median CD4 increase was 247 cells/ml and 34% experienced VF. AIDS and mortality rates at 5 years were 2% and 0.3%, respectively. In a MV model adjusted for known risk factors associated with treatment response, being on active duty (versus retired) at HAART initiation was associated with a decreased risk of AIDS (HR = 0.6, 95% CI 0.4-1.0) and mortality (0.6, 0.3-0.9), an increased probability of CD4 increase ≥ 50% (1.2, 1.0-1.4), but was not significant for VF.

Conclusions: In this observational cohort, VS rates approach those described in clinical trials. Initiating HAART on active duty was associated with even better outcomes. These findings support the notion that free access to healthcare likely improves the response to HAART thereby reducing HIV-related morbidity and mortality.

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Figures

Figure 1
Figure 1
HAART usage in the Natural History Study. (A) Distribution of prior ARV use and first regimen type by year of HAART initiation with duration of HIV infection prior to HAART start for seroconverters. (B) Therapy changes over time. The declining percentage of patients remaining on the first HAART regimen results from complete discontinuation of or changes in therapy.
Figure 2
Figure 2
KM curves for cumulative clinical outcomes for patients after HAART initiation stratified by HAART Era. (A) First AIDS event (B) Mortality.
See this image and copyright information in PMC

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