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ObjectiveTo estimate the rate of combination antiretroviral treatment change and factors associated with combination antiretroviral treatment change among patients recruited in the Australian HIV Observational Database (AHOD). MethodsAnalyses were based on patients in the AHOD who had commenced combination antiretroviral treatment after 1 January 1997. Combination antiretroviral treatment change was de®ned as the addition or change of at least one antiretroviral drug. A random-effect Poisson regression model was used to assess factors associated with increased rates of combination antiretroviral treatment change. ResultsA total of 596 patients in the AHOD were included in the analysis, with a median follow-up of 2.3 years. The overall rate of antiretroviral treatment change in this group was 0.45 combinations per year. In a multivariate analysis, a low CD4 count (, 200 cells/mL) at baseline was associated with an increased rate of treatment change [rate ratio (RR) 1.43; 95% con®dence interval (CI), 1.13, 1.80; P 0.003)]. Combinations including a nonnucleoside reverse transcriptase inhibitor were also associated with slower rates of change than treatment combinations including a protease inhibitor (RR 0.64, 95% CI, 0.51, 0.80, P , 0.001). ConclusionInitiating combination antiretroviral at a CD4 cell count , 200 cells/mL may be associated with poorer patient outcomes. However, the possibility that clinician or patient concerns about low immunological status led to faster rates of treatment change in this group cannot be discounted.

Objective: To describe time trends and demographic, exposure and clinical factors associated with late HIV presentation among notified AIDS cases diagnosed in Australia in 1992–2001. Methods: AIDS cases, diagnosed in Australia and notified to the National AIDS Registry, were included in the analysis. AIDS cases newly diagnosed with HIV infection within three months of AIDS diagnosis were defined as cases of late HIV presentation. Results: The percentage of AIDS cases with late HIV presentation increased significantly from 18% in 1992–96 to 33.1% in 1997 (adjusted odds ratio (AOR)=1.79, p<0.005) and to 49.6% in 2001 (AOR=3.01, p<0.005). Older age, having been born in Asia, a HIV exposure history of heterosexual contact or an ‘other/undetermined’ exposure and a diagnosis of PCP only or of multiple AIDS illnesses, were associated with late HIV presentation among AIDS cases diagnosed in 1992–96 and in 1997–2001, and among overseas‐born cases diagnosed in 1992–2001. In 1997–2001, a low CD4+ cell count was also associated with late HIV presentation. Among homosexually active men diagnosed with AIDS in 1997–2001, older age, a diagnosis of PCP or multiple AIDS illnesses and a low CD4+ cell count were associated with late HIV presentation. Conclusion: Predictors of late HIV presentation have remained substantially unchanged over time and among population subgroups, suggesting a need for innovation in HIV/AIDS testing and counselling strategies.

An increased proportion of PCP relative to other ADIs suggests an increasing proportion of AIDS patients not receiving specific prophylaxis, presumably because of "late" HIV diagnosis. Survival following almost all ADIs has increased in the era of HAART, although the prognosis after NHL remains extremely poor.

IntroductionThe use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals.Materials and MethodsA set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed.ResultsNone of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR-145 correlated with nadir CD4+ T cell count.DiscussionNo associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection.