177. HIV Treatment Outcomes in the Active Duty US Air Force Population
Session: Poster Abstract Session: ART Prescribing Errors
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Matthews IDSA 2013 Poster Final.pdf (256.8 kB)
  • Background: The United States Air Force (USAF) HIV program has several features that may enhance antiretroviral therapy (ART) outcomes, including mandated clinical visits every 6 months at a single center and free access to healthcare and prescription medications.  We evaluated ART outcomes over a 7-year period in the USAF active duty HIV population.

    Methods: Eligible subjects were USAF active duty members diagnosed with HIV between January 2006 and March 2012 (n=305).  Treatment naïve subjects started on continuous ART for ≥12 months were included (n=182).  The outcomes of viral load (VL) suppression (<400 copies/mL) and CD4 cell gains (cells/μL) at 12 months post-ART (n=116) were compared for those initiating non-nucleoside reverse transcriptase inhibitor (NNRTI)-based (n=58, 50%), integrase strand transfer inhibitor (INSTI)-based (n=35, 30.2%), and protease inhibitor (PI)-based (n=23, 19.8%) regimens.  VL suppression and AIDS outcomes up to 24 months post-ART were also evaluated.

    Results: Demographic and HIV characteristics were similar between ART groups (p=NS for all).  Subjects were predominantly male (n=177, 97%) with a mean age of 30 (±8) years at HIV diagnosis.  At ART initiation, the mean VL was 4.4 (±0.7) log10 copies/mL and mean CD4 count was 441 (±220) cells/μL. VL suppression at 12 months was similar between ART groups: 94.8% (55 of 58) for NNRTI-based, 97.1% (34 of 35) for INSTI-based, and 100% (23 of 23) for PI-based ART (χ21.38; p=0.50). However, CD4 gains were greater for INSTI-based (322 ±281 cells/μL) compared to NNRTI- and PI-based regimens (209 ±173 and 256 ±137 cells/μL, respectively; p=0.04).  VL suppression remained high for the 3 combined groups during follow-up, with 83 of 89 (93.3%) and 76 of 79 (96.2%) subjects maintaining VL <400 copies/mL at 18 and 24 months, respectively. There was only 1 AIDS diagnosis of Burkitt lymphoma observed during treatment.

    Conclusion: Similar to results from recent ART clinical trials, very high rates of VL suppression were observed in the USAF HIV program regardless of ART regimen selection. These results suggest that excellent treatment outcomes can be achieved with use of potent ART combined with a structured program that minimizes traditional barriers to HIV care.

    Peter Matthews, MD and Jason Okulicz, MD, Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, TX

    Disclosures:

    P. Matthews, None

    J. Okulicz, None

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