693. Decreasing Time To ART Initiation and Virologic Suppression in a Large Clinical Cohort
Session: Poster Abstract Session: Adherence, Retention in Care, and the HIV Cascade
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 693_IDWPOSTER.pdf (197.9 kB)
  • Background: In the modern antiretroviral (ART) era our understanding of HIV infection and treatments have advanced considerably. As a result, HIV clinical care has evolved. We sought to evaluate the time to ART initiation (AI) and HIV virologic suppression (VS) in a large clinical cohort in the modern ART era.

    Methods: We reviewed data from all newly presenting adults at 14 clinics in the HIV Research Network from 2003-11. We categorized enrollment date into 2 year intervals. Time to AI and time to VS were defined as time from enrollment to AI and HIV RNA <400 copies/ml, respectively. CD4 count at AI was the CD4 count (CD4) closest to AI +/- 90 days. Cuzick's test was used for non-parametric trends. Competing risk regression models were used to estimate the subhazard ratio (SHR) for time to AI and VS by enrollment date category with loss to follow-up (LTFU) as the competing risk. Cumulative Incidence of AI and VS was displayed using competing risks regression.

    Results: Among 14,010 new presenters, 76.4% were male, 48.6% Black, 11.5% were IDU with median age of 38 (interquartile range: 30-46 years). Median CD4 count at AI was 203 cells/mm3 in 2003-04 and increased to 251 cells/mm3 in 2009-10 (test for trend p<0.001). Cumulative incidence of AI was 75%, and 56% became suppressed.  Antiretroviral initiation within 2 years from enrollment increased from 63% in 2003 to 77% in 2010 and VS increased from 43% in 2003 to 58% in 2010. Risk for AI and VS prior to LTFU increased as CD4 category decreased.

     

    Table 1. Multivariable Model of Subhazard Ratio of ART Initiation and HIV Suppression*

     

    ART Initiation

    HIV Suppression

    Variable

    SHR (95% CI)

    SHR (95% CI)

    Enrollment Year

    2003-04

    Ref

    Ref

    2005-06

    1.05 (0.99 - 1.11)

    1.16 (1.08 - 1.24)

    2007-08

    1.17 (1.11 - 1.24)

    1.53 (1.43 - 1.64)

    2009-10

    1.39 (1.30 - 1.47)

    1.93 (1.80 - 2.07)

    *adjusted for CD4 category, age, gender, race/ethnicity, HIV risk, and clinic site

    Figure 1. Cumulative Incidence of ART Initiation and of Virologic Suppression Within 2 Years From Enrollment Using Competing Risks Regression

     

    Conclusion: In the HIVRN cohort, the time from enrollment to AI and VS have decreased significantly since 2007 as compared to the period before (2003-2004). These data highlight improvements in the HIV care cascade and the importance of assessing longitudinal trends to inform practice and interventions.

     

    Charles Haines, MD1, Baligh R. Yehia, MD, MPP, MSHP2, Allison Agwu, MD1 and Kelly Gebo, MD, MPH1, (1)Johns Hopkins University School of Medicine, Baltimore, MD, (2)University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

    Disclosures:

    C. Haines, None

    B. R. Yehia, None

    A. Agwu, None

    K. Gebo, Tibotec: Scientific Advisor, Research grant and Salary
    BMS: Scientific Advisor, Salary

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